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Sample records for ct-guided percutaneous radiofrequency

  1. CT-guided percutaneous radiofrequency ablation of spinal osteoid osteoma

    Institute of Scientific and Technical Information of China (English)

    LIU Chen; LIU Xiao-guang; ZHU Bin; YUAN Hui-shu; HAN Song-bo; MA Yong-qiang

    2011-01-01

    Background This study evaluated the feasibility,efficacy and safety of CT-guided percutaneous radiofrequency ablation in patients with spinal osteoid osteoma.Methods Two patients suffered spinal osteoid osteoma were treated with CT-guided percutaneous radiofrequency ablation under local anesthesia.Lesions located in sacral vertebrae and cervical vertebrae,which were adjacent to nerve root and spinal canal respectively.Tumors were treated under 90°C radiofrequency temperature lasting 4 minutes by an electrode placement.Visual analog scale was used to evaluate the pain improvement.Results No complications were observed pre- and post-operation.Patients recovered to normal activities immediately and achieved complete pain relief in 24 hours.No symptoms were recurrent in 5 months and 4 months follow up.Mild scoliosis has been recovered in case 2.Conclusions CT-guided percutaneous radiofrequency ablation of spinal osteoid osteoma is safe,effective and has more clinical benefits.The long-term outcome needs further observation.

  2. CT-guided percutaneous radiofrequency denervation of the sacroiliac joint

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    Gevargez, A.; Schirp, S.; Braun, M. [Department of Radiology and Microtherapy, University of Witten/Herdecke, Bochum (Germany); Groenemeyer, D. [Department of Radiology and Microtherapy, University of Witten/Herdecke, Bochum (Germany); EFMT Development and Research Center for Microtherapy, Bochum (Germany)

    2002-06-01

    Defining the origin of low back pain is a challenging task. Among a variety of factors the sacroiliac joint (SIJ) is a possible pain generator, although precise diagnosis is difficult. Joint blocks may reduce pain, but are, in cases, of only temporary effect. This study was conducted to evaluate CT-guided percutaneous radiofrequency denervation of the sacroiliac joint in patients with low back pain. The procedure was performed on 38 patients who only temporarily responded to CT-guided SIJ blocks. The denervation was carried out in the posterior interosseous sacroiliac ligaments and on the dorsal rami of the fifth spinal nerve. All interventions were carried out under CT guidance as out-patient therapies. Three months after the therapy, 13 patients (34.2%) were completely free of pain. Twelve patients (31.6%) reported on a substantial pain reduction, 7 patients (18.4%) had obtained a slight and 3 patients (7.9%) no pain reduction. The data of 3 patients (7.9%) was missing. There were no intra- or postoperative complications. Computed tomography-guided percutaneous radiofrequency denervation of the sacroiliac joint appears safe and effective. The procedure may be a useful therapeutic modality, especially in patients with chronic low back pain, who only temporarily respond to therapeutic blocks. (orig.)

  3. Percutaneous CT-guided radiofrequency ablation of solitary small renal masses. A single center experience

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    Pieper, C.C.; Fischer, S.; Strunk, H.; Meyer, C.; Thomas, D.; Willinek, W.A.; Schild, H. [Univ. Bonn (Germany). Dept. of Radiology; Hauser, S. [Univ. Bonn (Germany). Dept. of Urology; Nadal, J. [Univ. Bonn (Germany). Inst. for Medical Biometry; Wilhelm, K. [Johanniter Hospital Bonn (Germany). Dept. of Radiology

    2015-07-15

    To analyze the outcome of patients undergoing percutaneous CT-guided radiofrequency ablation (RFA) of small renal masses (SRM) at a single center during a ten-year time period. Patient records of renal RFAs (07/2003 - 11/2013) were reviewed. Indications were SRM suspicious of malignancy on imaging and one of the following: severe comorbidity; old age; solitary kidney; impaired renal function; patient wish. Biopsy was performed at the time of RFA. Patients were excluded if no follow-up was available. Patient and procedural characteristics were recorded. Survival rates were calculated using the Kaplan-Meier's method and compared with log-rank or cox tests. 38 patients (16 females, mean age 70.0 years [range 52 - 87]) presenting with a solitary SRM were included in the study. Biopsy showed malignancy in 29 patients; 9 had benign tumors. 26 patients suffered from cardiovascular, respiratory or hepatic comorbidities. Technical success (complete ablation on first follow-up) was achieved in 95 % of cases. Two major complications (bowel perforation; hematothorax) occurred. The 3- and 7-year overall survival (OS) [any cause] rates were 73.4 ± 0.8 % and 50.3 ± 1.0 %, respectively (mean follow-up 54.6 months, range 1 - 127). 4 recurrences and 2 metastases were observed. The presence of comorbidities was the only independent predictor of OS. There was no difference in survival between patients with benign and malignant tumors. RFA of SRM is successful in a large percentage of cases with a low complication rate and durable local control. As RFA is typically performed in multimorbid patients, overall survival seems to depend primarily on comorbidities rather than cancer progression.

  4. Treatment of osteoid osteoma with CT-guided percutaneous radiofrequency thermoablation.

    Science.gov (United States)

    de Palma, Luigi; Candelari, Roberto; Antico, Ettore; Politano, Rocco; Luniew, Eugenio; Giordanengo, Maurizio; Di Giansante, Silvio; Marinelli, Mario; Paci, Enrico

    2013-05-01

    Osteoid osteoma is a benign bone tumor with a male predominance occurring mainly in children and young adults. The most common symptom is intermittent pain that worsens at night and is at least partially relieved by nonsteroidal anti-inflammatory drugs. The purpose of this study was to assess the long-term effectiveness of computed tomography-guided percutaneous radiofrequency thermoablation in patients with a minimum follow-up of 2 years. Twenty patients with osteoid osteoma (15 men and 5 women) with a mean age of 20.7 years (range, 4-61 years; 12 patients aged 20 years or younger) underwent computed tomography-guided percutaneous radiofrequency thermoablation. Lesion sites were the femur (n=9), tibia (n=7), pelvis (n=1), talus (n=1), cuneiform bone (n=1), and humerus (n=1). Mean follow-up was 44 months (range, 3-106 months). Pain relief was significant in 95% of patients; it disappeared within 24 hours in 14 patients, within 3 days in 4, and within 7 days in 1. The patient with persistent symptoms underwent another percutaneous radiofrequency thermoablation procedure that was successful. The difference between pre- and postoperative pain was significant (P ≤ .01). No recurrences occurred. Computed tomography-guided percutaneous radiofrequency thermoablation is a safe, minimally invasive, and economical procedure with high technical and clinical success rates, and it effectively and durably enhances quality of life.

  5. Percutaneous CT-guided interventional procedures in musculoskeletal system (our experience)

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    Thanos, Loukas E-mail: loutharad@yahoo.com; Mylona, Sophia; Kalioras, Vasilios; Pomoni, Maria; Batakis, Nikolaos

    2004-06-01

    Percutaneous interventional procedures include a broad spectrum of minimal invasive techniques, which are a useful diagnostic and therapeutic tool. In this study we present our experience in CT-guided percutaneous musculoskeletal biopsies, drainages of musculoskeletal abscesses, facet and sacroiliac joint injection and radiofrequency thermal ablation of painful metastases or osteoid osteomas.

  6. CT-guided Percutaneous Radiofrequency Ablation for Spinal Osteoid Osteoma: Report of 3 Cases%CT引导下经皮穿刺射频消融术治疗脊柱骨样骨瘤3例报告

    Institute of Scientific and Technical Information of China (English)

    柳晨; 刘晓光; 祝斌; 袁慧书; 韩嵩博; 马永强

    2011-01-01

    Objective To evaluate the preliminary clinical outcome of CT-guided percutaneous radiofrequency ablation in patients with spinal osteoid osteoma. Methods Three patients who suffered spinal osteoid osteoma were treated with CT-guided percutaneous radiofrequency ablation under local anesthesia. The lesions located in the cervical vertebral body, lumbar vertebral transverse process and sacral vertebral body, respectively, which were all adjacent to the spinal cord and nerve root. The tumors were damaged with radiofrequency at 90 "C for 4 minutes. Results No complications occured pre- and postoperation. The mean follow-up was 5 months (2, 6, and 7 months, respectively). All the cases obtained satisfactory pain relief. The VAS decreased by6, 8, and 8 respectively. No recurrence or nerve dysfunction occurred during the follow-up. Conclusions CT-guided percutaneous radiofrequency ablation of spinal osteoid osteoma is safe, minimal invasive and well-tolerated. It has exact curative effect in short-term. Further observation is needed to determine whether it can replace traditional operative resection.%目的 评价CT引导下经皮穿刺射频消融术治疗脊柱骨样骨瘤的临床效果.方法 3例脊柱骨样骨瘤,分别位于颈椎、腰椎和骶椎,肿瘤边缘紧邻脊髓或神经.局部麻醉后,CT引导下经皮穿刺将射频电极置入骨样骨瘤中心,应用90℃的射频高温持续4 rain对瘤巢进行损毁.结果 术中及术后无明显并发症发生.术后分别随访2、6、7个月(平均5个月),疼痛缓解满意,3例VAS评分分别下降了6、8、8分,随访期内疼痛无复发,无神经功能损害.结论 CT引导下经皮穿刺射频消融术治疗脊柱骨样骨瘤微创、安全,患者耐受性好,近期效果确切.

  7. CT-guided radiofrequency tumor ablation in children

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    Botsa, Evanthia [National and Kapodistrian University of Athens, First Pediatric Clinic, Agia Sofia Children' s Hospital, Athens (Greece); Poulou, Loukia S.; Koundouraki, Antonia; Thanos, Loukas [Sotiria General Hospital for Chest Diseases, Department of Medical Imaging and Interventional Radiology, Athens (Greece); Koutsogiannis, Ioannis [General Military Hospital NIMTS, Department of Medical Imaging, Athens (Greece); Ziakas, Panayiotis D. [Warren Alpert Medical School of Brown University Rhode Island Hospital, Division of Infectious Diseases, Providence, RI (United States); Alexopoulou, Efthimia [Attikon University Hospital, Second Department of Radiology, Athens University School of Medicine, Athens (Greece)

    2014-11-15

    Image-guided radiofrequency ablation is a well-accepted technique of interventional oncology in adults. To evaluate the efficacy and safety of CT-guided radiofrequency ablation as a minimally invasive treatment for metastatic neoplasms in children. A total of 15 radiofrequency ablation sessions were performed in 12 children and young adults (median age 9.5; range 5-18 years) with metastatic malignancies. Seven children and young adults had secondary hepatic lesions, three had pulmonary and two had bone lesions. Radiofrequency ablation was performed under conscious sedation. The median lesion size was 1.7 cm (range 1.3-2.8 cm). The median time for ablation was 8 min (range 7-10 min). Radiofrequency procedures were technically successful in all tumors. Postablation imaging immediately after, and 1 month and 3 months after radiofrequency ablation showed total necrosis in all patients. At 6-month follow-up, three patients (all with lesion size >2 cm) had local recurrence and underwent a second radiofrequency ablation session. At 2-year follow-up no patient had recurrence of the treated tumor. Post-ablation syndrome occurred in four children. No major complication occurred. CT-guided radiofrequency tumor ablation was safe and efficient for palliative treatment in our cohort of patients. (orig.)

  8. Debulking treatment with CT-guided percutaneous radiofrequency ablation and hepatic artery infusion of floxuridine improves survival of patients with unresectable pulmonary and hepatic metastases of colorectal cancer

    Institute of Scientific and Technical Information of China (English)

    Sheng Li; Ni He; Wang Li; Pei-Hong Wu

    2014-01-01

    The survival of most patients with both unresectable hepatic and pulmonary metastases of colorectal cancer is poor. In this retrospective study, we investigated the efficacy of computed tomography (CT)-guided radiofrequency ablation (RFA) and systemic chemotherapy plus hepatic artery infusion of floxuridine (HAI-FUDR). Sixty-one patients were selected from 1,136 patients with pulmonary and hepatic metastases from colorectal cancer. Patients were treated with RFA and systemic chemotherapy plus HAI-FUDR (ablation group, n=39) or systemic chemotherapy plus HAI-FUDR (FUDR group, n=22). Patients in the two groups were matched by sex, age, number of metastases, and calendar year of RFA or FUDR. Survival data were evaluated by using univariate and multivariate analyses. Clinical characteristics were comparable between the two groups. Al patients in the ablation group underwent RFA and chemotherapy. Median fol ow-up was 56.8 months. The 1-, 3-, and 5-year overall survival (OS) rates were 97%, 64%, and 37%, respectively, for the ablation group, and 82%, 32%, and 19%, respectively, for the FUDR group. The 1-, 3-, and 5-year survival rates after metastasis were 97%, 49%, and 26%for the ablation group, and 72%, 24%, and 24%for the FUDR group, respectively. The median OS times were 45 and 25 months for the ablation and FUDR groups, respectively. In the multivariate analysis, treatment al ocation was a favorable independent prognostic factor for OS (P = 0.001) and survival after metastasis (P = 0.009). These data suggest that the addition of RFA to systemic chemotherapy plus HAI-FUDR improves the survival of patients with both unresectable hepatic and pulmonary metastases from colorectal cancer.

  9. CT引导射频热凝术治疗三叉神经痛临床分析%Clinical analysis of CT guided percutaneous radiofrequency thermocoagulation for treatment of trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    王晓志

    2013-01-01

    Objective To analyze and evaluate the clinical effect of CT guided percutaneous semilunar ganglion radiofrequency thermocoagulation for treatment of trigeminal neuralgia.Methods 52 patients with trigeminal neuralgia treated in our hospital were selected.They underwent the CT three-dimensional guidance on trigeminal neuralgia Ⅱ,Ⅲ,Ⅱ + Ⅲ neuralgia neuralgia patients with anterior foramen ovale puncture semilunar ganglion,verify the operative target,and a standard radiofrequency target temperature damage under general anesthesia.Results Of the 52 patients,the treatment effect was excellent in 49 cases,good in 1 patient,the effect of other 2 cases was poor,the excellent and good rate was 96.15%.Conclusion CT guided percutaneous puncture semilunar ganglion radiofrequency thermocoagulation in the treatment of patients with trigeminal neuralgia is simple,safe,and easy to be accepted by patients,the cure rate is high,it is worth learning and promotion.%目的 对CT引导经皮穿刺半月神经节射频热凝术治疗三叉神经痛的临床效果进行分析和评价.方法 选取三叉神经痛患者52例,在CT三维引导下对三叉神经第Ⅱ支痛、第Ⅲ支痛、Ⅱ+Ⅲ支痛患者应用前入路卵圆孔穿刺半月神经节,术中验证靶点,并在全身麻醉下进行标准射频靶点温控毁损.结果 52例患者中,经治疗效果优49例,良1例,差2例,优良率为96.15%.结论 对三叉神经痛患者采用CT引导经皮穿刺半月神经节射频热凝术治疗,简单、安全,且患者易于接受,治愈率较高,值得借鉴和推广.

  10. Osteoid osteoma of the spine: CT-guided monopolar radiofrequency ablation

    Energy Technology Data Exchange (ETDEWEB)

    Martel, Jose [Departamento de Diagnostico por Imagen, Fundacion Hospital Alcorcon, Alcorcon, Madrid (Spain)], E-mail: jmartel@fhalcorcon.es; Bueno, Angel [Departamento de Diagnostico por Imagen, Fundacion Hospital Alcorcon, Alcorcon, Madrid (Spain); Nieto-Morales, M Luisa [Servicio de Radiologia, Hospital Universitario de Tenerife (Spain); Ortiz, Eduardo J. [Departamento de Cirugia Ortopedica, Fundacion Hospital Alcorcon, Alcorcon, Madrid (Spain)

    2009-09-15

    CT-guided percutaneous radiofrequency ablation and laser photocoagulation have become the methods of choice for the treatment of all osteoid osteomas except those in contact with neural structures. We report 10 patients with spinal osteoid osteoma adjacent to the neural elements treated with 12 sessions of CT-guided monopolar radiofrequency ablation. The size range of the lesion was 3-14 mm (mean, 7.5 mm) and the distance between the nidus and the adjacent spinal cord or nerve root was 2-12 mm (mean, 5 mm). No intact cortex between the tumor and the spinal cord or nerve roots constituted an exclusion criterion because of a higher risk of undesirable neurotoxic effects. Patients were under general anesthesia. After location of the lesion, a 11G-bone biopsy was introduced into the nidus. The radiofrequency electrode was inserted through the biopsy needle and heated at 90 deg. C for 4 min. Primary success was obtained in eight patients. At follow-up (mean, 19.5 months; range, 6-24 months), pain persisted in two patients after 2 months. Both of them were re-treated. All patients are currently pain-free and complications were not detected. In our opinion, radiofrequency ablation can also be considered the treatment of choice for spinal osteoid osteoma.

  11. Palmar hyperhidrosis - CT guided chemical percutaneous thoracic sympathectomy

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    Adler, O.B.; Engel, A.; Rosenberger, A. (Technion-Israel Inst. of Tech., Haifa (Israel). Dept. of Diagnostic Radiology); Dondelinger, R. (Centre Hospitalier, Luxembourg (Luxembourg). Dept. of Diagnostic Radiology)

    1990-10-01

    Palmar hyperhidrosis or excessive sweating of the hands causes, to those affected, emotional and physical disturbance and impediment in professional and social life. The cause is unknown. Sweat glands are innervated by the sympathic chain of the autonomous nervous system. The center of sympathic regulation of the upper extremities is located between the segments of D.2-D.9 of the spinal cord. Accepted treatment consists of surgery aimed to excise the third thoracic sympathic ganglion. CT guided chemical percutaneous thoracic sympathectomy presents an alternative, which in the event of failure does not prevent ensuing surgery. The preliminary experience with this procedure in 50 patients is presented and discussed. (orig./GDG).

  12. Treatment of osteoid osteoma using CT-guided radiofrequency ablation versus MR-guided laser ablation: A cost comparison

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    Maurer, M.H., E-mail: martin.maurer@charite.de [Charite - Universitaetsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany); Gebauer, B., E-mail: bernhard.gebauer@charite.de [Charite - Universitaetsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany); Wieners, G., E-mail: gero.wieners@charite.de [Charite - Universitaetsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany); De Bucourt, M., E-mail: maximilian.de-bucourt@charite.de [Charite - Universitaetsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany); Renz, D.M., E-mail: diane.renz@charite.de [Charite - Universitaetsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany); Hamm, B., E-mail: bernd.hamm@charite.de [Charite - Universitaetsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany); Streitparth, F., E-mail: florian.streitparth@charite.de [Charite - Universitaetsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany)

    2012-11-15

    Objective: To compare the costs of CT-guided radiofrequency ablation (RFA) and MR-guided laser ablation (LA) for minimally invasive percutaneous treatment of osteoid osteoma. Materials and methods: Between November 2005 and October 2011, 20 patients (14 males, 6 females, mean age 20.3 {+-} 9.1 years) underwent CT-guided RFA and 24 patients (18 males, 6 females; mean age, 23.8 {+-} 13.8 years) MR-guided LA (open 1.0 Tesla, Panorama HFO, Philips, Best, Netherlands) for osteoid osteoma diagnosed on the basis of clinical presentation and imaging findings. Prorated costs of equipment use (purchase, depreciation, and maintenance), staff costs, and expenditure for disposables were identified for CT-guided RFA and MR-guided LA procedures. Results: The average total costs per patient were EUR 1762 for CT-guided RFA and EUR 1417 for MR-guided LA. These were (RFA/LA) EUR 92/260 for equipment use, EUR 149/208 for staff, and EUR 870/300 for disposables. Conclusion: MR-guided LA is less expensive than CT-guided RFA for minimally invasive percutaneous ablation of osteoid osteoma. The higher costs of RFA are primarily due to the higher price of the disposable RFA probes.

  13. CT-guided percutaneous radiofrequency ablation in osteoid osteoma. Re-assessments of results with optimized technique and possible pain patterns in mid-term follow-up

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    Omlor, G.; Merle, C.; Lehner, B.; Ewerbeck, V. [Universitaetsklinik Heidelberg (Germany). Orthopaedische Universitaetsklinik; Rehnitz, C.; Weber, M.A. [Universitaetsklinik Heidelberg (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Ludwig, K. [Klinikum Herford (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie

    2012-04-15

    To re-assess radiofrequency ablation (RFA) of osteoid osteoma (OO) with an optimized technique and to evaluate patterns of post-interventional pain important for the detection of recurrence. 44 consecutive patients with OO treated with precise inclusion criteria by RFA were examined retrospectively. RFA was performed with an optimized technique. Technical success (TS), primary and secondary clinical success (PCS/SCS) and minor and major complications (MIC/MAC) were evaluated. Pain patterns defined as 'osteoid osteoma-specific pain' (OOSP) and 'unspecific pain' (UP), 'limitations in daily activity' (LDA) and 'patient satisfaction' (PS) were evaluated using a numeric rating scale (0 - 10; 0 = no pain, 0 = no limitation, 10 = fully satisfied). The pain intensity before and after RFA was compared. The mean follow-up time was 35 months (n = 40, range 2 - 60 months). TS was 100 % (n = 44), PCS 98 % (n = 44), and SCS 100 % (n = 40). MIC and MAC were 0 % (n = 44). OOSP was 0 after RFA in all 44 patients. UP was 0 in 24 of 40 patients (60 %), 1 in 11 patients (28 %) for up to 7 days and 1 - 4 in 5 patients (13 %) for 30 - 180 days. LDA was 0 in 39 of 40 patients (98 %), and 1 in 1 patient. PS was 10 in all patients. The pain after RFA was significantly less than before RFA (p < 0.0001). Using an optimized technique primary clinical success rates in the high nineties have to be expected. Unspecific pain of low intensity is not unusual after RFA and has to be distinguished from pain caused by recurrent disease. (orig.)

  14. CT 引导下经皮射频消融治疗肾上腺皮质腺瘤库欣综合征%CT-guided percutaneous radiofrequency ablation for adrenocortical adenoma with Cushing's syndrome

    Institute of Scientific and Technical Information of China (English)

    屈峰; 查振雷; 周科峰; 连惠波; 张古田; 汪维; 兰厚金; 甘卫东; 郭宏骞

    2015-01-01

    目的:评价CT引导下经皮射频消融( radiofrequency ablation ,RFA)治疗肾上腺皮质腺瘤库欣综合征( Cushing's syndrome )的可行性、安全性、疗效和不良反应。方法自2009年1月至2013年12月,采用CT引导下射频消融治疗肾上腺皮质腺瘤库欣综合征患者24例,共24个肿瘤。平均肿瘤直径(2.1±0.7)(1.1~3.9)cm。采用CT实时扫描引导下进行射频消融。术后1周复查增强CT扫描,肿瘤病灶无强化定义为消融成功。术后随访血清皮质醇及促肾上腺皮质激素较术前明显改善,且症状改善定义为临床治愈。射频消融术后肿瘤病灶穿刺活检取病理明确诊断。结果24例手术均获成功,无中转开放。术中患者出现血压波动,未发生高血压危象,6例术后出现腰部轻微疼痛。术后1周CT增强扫描显示24个肿瘤完全消融。24例平均随访18(3~36)个月,血清皮质醇及促肾上腺皮质激素基本恢复到正常水平,库欣综合征相关症状也逐渐改善,随访过程中未见肿瘤复发。病理活检结果均为肾上腺皮质腺瘤。所有患者均无严重并发症发生。结论 CT引导下RFA治疗具有库欣综合征的肾上腺皮质腺瘤是一种安全可行、有效、并发症少的微创治疗方法。%Objective To evaluate the feasibility , safety, therapeutic effects and adverse reactions of CT-guided radiofrequency ablation (RFA)for adrenocortical adenoma with Cushing's syndrome.Methods From Jan.2009 to Dec.2013, 24 patients with 24 tumors diagnosed as adrenocortical adenoma with Cushing's syn-drome received CT-guided percutaneous RFA.The average tumor size was(2.1 ±0.7)cm(ranging from 1.1 to 3.9 cm) .RFA was performed under real-time computed tomography guidance .Technical success was defined as disappearance of tumor enhancement on contrast CT imaging 1 week after RFA .Clinical success was defined as improvement in serum cortisol, adreno

  15. Percutaneous CT-guided treatment of recurrent spinal cyst hydatid.

    Science.gov (United States)

    Ozdemir, Ozgur; Calisaneller, Tarkan; Yildirim, Erkan; Altinors, Nur

    2011-01-01

    The involvement of spinal column in cyst hydatid disease is rare and hard to treat. The gold standard treatment is total removal of the cysts without rupture. However, recurrence after surgery is almost inevitable and reoperations carries technical difficulties and higher morbidity. We present a 69-year-old woman with two cystic masses at the T12 level, which compress the spinal cord causing severe paresis in her left leg. Under local anestesia, the cysts were aspirated and irrigated with 20% hypertonic saline solution via bilateral T12 transpedicular route. We aimed to report that percutaneous CT guided treatment should be considered as an alternative therapeutic option in case of recurrent spinal cyst hydatid.

  16. CT-guided radiofrequency ablation of osteoid osteoma: long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Cioni, Roberto; Armillotta, Nicola; Bargellini, Irene; Zampa, Virna; Cappelli, Carla; Vagli, Paola; Bartolozzi, Carlo [Department of Oncology, Transplants and Advanced Technologies in Medicine, Division of Diagnostic and Interventional Radiology, University of Pisa, Via Roma 67, 56126, Pisa (Italy); Boni, Giuseppe [Division of Nuclear Medicine, University of Pisa, Via Roma 67, 56126, Pisa (Italy); Marchetti, Stefano; Consoli, Vincenzo [Department of Orthopedics, University of Pisa, Via Roma 67, 56126, Pisa (Italy)

    2004-07-01

    The aim of the study was to assess the safety and efficacy of CT-guided percutaneous radiofrequency (RF) ablation of osteoid osteoma (OO). From 1997 to 2001, RF ablation was performed on 38 patients with OO, diagnosed clinically and by radiography, scintigraphy, contrast-enhanced MRI, and CT. Treatment was performed via percutaneous (n=29) or surgical (n=9) access, under CT guidance in all cases, with an 18-gauge straight electrode. Patients were discharged within 24 h and followed up clinically (at 1 week and every 6-12 months) and with MRI (at 6 months) and scintigraphy (after 1 year). The technical success rate was 100%. Complications occurred in two patients, consisting in local skin burns. The follow-up range was 12-66 months (mean {+-} SD, 35.5{+-}7.5 months). Prompt pain relief and return to normal activities were observed in 30 of 38 patients. Persistent pain occurred in eight patients; two patients refused further RF ablation and were treated surgically; RF ablation was repeated in six cases achieving successful results in five. One patient reported residual pain and is being evaluated for surgical excision. Primary and secondary clinical success rates were 78.9 (30/38 patients) and 97% (35/36 patients), respectively. CT-guided RF ablation of OO is safe and effective. Persistent lesions can be effectively re-treated. Several imaging modalities are needed for the diagnosis of OO and for the follow-up after treatment, particularly in patients with persistent symptoms. (orig.)

  17. Percutaneous radiofrequency thermocoagulation of osteoid osteomas: factors affecting therapeutic outcome

    Energy Technology Data Exchange (ETDEWEB)

    Cribb, G.L.; Goude, W.H.; Cool, P.; Tins, B.; Cassar-Pullicino, V.N.; Mangham, D.C. [Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry (United Kingdom)

    2005-11-01

    To examine factors which affect local recurrence of osteoid osteomas treated with percutaneous CT-guided radiofrequency thermocoagulation. A prospective study was carried out on 45 patients with osteoid osteoma who underwent percutaneous radiofrequency thermocoagulation with a minimum follow-up of 12 months There were seven local recurrences (16%); all occurred within the first year. Local recurrence was significantly related to a non-diaphyseal location (P<0.01). There was no significant relationship (P=0.05) between local recurrence and age of the patient, duration of symptoms, previous treatment, size of the lesion, positive biopsy, radiofrequency generator used or the number of needle positions. There were no complications. Osteoid osteomas in a non-diaphyseal location are statistically more likely to recur than those in a diaphyseal location when treated with CT-guided percutaneous radiofrequency thermocoagulation. This relationship between local recurrence and location has not been previously reported. (orig.)

  18. CT-guided radiofrequency ablation of spinal osteoid osteomas with concomitant perineural and epidural irrigation for neuroprotection

    Energy Technology Data Exchange (ETDEWEB)

    Klass, Darren [Norfolk and Norwich University Hospital, Department of Radiology, Norwich (United Kingdom); Norfolk and Norwich University Hospital, Radiology Academy, Cotman Centre, Norwich (United Kingdom); Marshall, Tom; Toms, Andoni [Norfolk and Norwich University Hospital, Department of Radiology, Norwich (United Kingdom)

    2009-09-15

    Here we report our experience of a neuroprotective adaptation of the technique of CT-guided radiofrequency (RF) ablation of spinal osteoid osteomas. Over 9 years seven patients underwent eight CT-guided RF treatments for osteoid osteoma. CT-guided RF ablation was performed with general anaesthesia. The lesion was heated to 90 C for 2 min for two cycles by using a Cosman SMK TC-10 RF electrode. This was preceded by a bolus of room temperature sterile water (10 ml) injected through a 26G curved spinal needle into the exit foramen and adjacent epidural space for neuroprotection. The age of the patient, sex, lesion location, biopsy results and complications were recorded. All the biopsies (n = 7) demonstrated histological features of osteoid osteoma. All the procedures were technically successful. Clinical success was assessed up to 3 years post procedure. There was an 85% clinical success rate (6 of the 7 patients), with recurrence of a lesion at 6 months, necessitating a repeat procedure (successful). CT-guided percutaneous RF ablation of spinal osteoid osteoma preceded by bolus of sterile water, injected through a spinal needle into the exit foramen and adjacent epidural space for neuroprotection, is a safe and effective procedure. (orig.)

  19. Accuracy of CT-guided percutaneous core needle biopsy for assessment of pediatric musculoskeletal lesions

    Energy Technology Data Exchange (ETDEWEB)

    Hryhorczuk, Anastasia L. [University of Michigan, Department of Radiology, C. S. Mott Children' s Hospital, Ann Arbor, MI (United States); Harvard University School of Medicine, Department of Radiology, Boston Children' s Hospital, Boston, MA (United States); Strouse, Peter J. [University of Michigan, Department of Radiology, C. S. Mott Children' s Hospital, Ann Arbor, MI (United States); Biermann, J.S. [University of Michigan, Department of Orthopaedic Surgery, Ann Arbor, MI (United States)

    2011-07-15

    CT-guided percutaneous core needle biopsy has been shown in adults to be an effective diagnostic tool for a large number of musculoskeletal malignancies. To characterize our experience with CT-guided percutaneous core needle biopsy of pediatric bone lesions and determine its utility in diagnosing pediatric osseous lesions, in a population where such lesions are commonly benign. From 2000 to 2009, 61 children underwent 63 CT-guided percutaneous biopsies. Radiological, pathological and clinical records were reviewed. Fourteen biopsies (22%) were performed on malignant lesions, while 49 biopsies (78%) were performed on benign lesions. Forty-nine of the 63 biopsies (78%) were adequate; these children underwent no further tissue sampling. Fourteen of the 63 biopsies (22%) were inadequate or non-conclusive. Of these patients, 12 underwent open biopsy. Retrospective analysis of percutaneous biopsies in these patients demonstrates that 9/12 provided clinically relevant information, and 4/12 patients received final diagnoses that confirmed initial core biopsy findings. No malignancies were diagnosed as benign on percutaneous biopsy. Overall, percutaneous core needle biopsy provided accurate diagnostic information in 84% (53/63) of biopsies. Our results demonstrate that CT-guided percutaneous biopsy is safe and beneficial in children. This study supports the use of CT-guided percutaneous core needle biopsy for primary diagnosis of pediatric bone lesions. (orig.)

  20. Therapeutic impact of CT-guided percutaneous catheter drainage in treatment of deep tissue abscesses

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    Asai, Nobuhiro; Ohkuni, Yoshihiro; Kaneko, Norihiro; Aoshima, Masahiro; Yamazaki, Ikuo; Kawamura, Yasutaka, E-mail: nobuhiro0204@hotmail.com [Kameda Medical Center, Chiba (Japan)

    2013-03-15

    Combination therapy of CT-guided percutaneous drainage and antibiotics is the first-line treatment for abscesses. Its effectiveness has been demonstrated. However, the therapeutic impact of this procedure for infection treatment has never been reported. We retrospectively analyzed all 47 patients who received CT-guided percutaneous drainage for infection treatment. Patients' characteristics, pathogens isolated, antibiotics administered, technical and clinical outcomes, complications related to this procedure and therapeutic impacts were investigated. Patients were 26 males and 21 females. The mean age was 63.5 years ({+-}18.7). The diseases targeted were 19 retroperitoneal abscesses, 18 intraabdominal abscesses, three pelvic abscesses, and seven others. As for technical outcomes, all of the 54 procedures (100%) were successful. As for clinical outcomes, 44 (93.6%) were cured and three patients (6.4%) died. No complications related to this procedure were found in this study. A total of 42 patients (88%) had a change in the management of their infection as a result of CT-guided percutaneous drainage, such as selection and discontinuation of antibiotics. In conclusion, CT-guided percutaneous drainage is a safe and favorable procedure in the treatment of deep tissue abscesses. Therapeutic impact of these procedures helped physicians make a rational decision for antibiotics selection. (author)

  1. CT-guided percutaneous drainage within intervertebral space for pyogenic spondylodiscitis with psoas abscess

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    Matsumoto, Tomohiro; Morishita, Hiroyuki; Lida, Shigeharu; Asai, Shunsuke; Masui, Koji; Sato, Osamu (Department of Diagnostic Radiology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto (Japan)), Email: t-matsu@koto.kpu-m.ac.jp; Yamagami, Takuji; Nishimura, Tsunehiko (Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto (Japan)); Yamazoe, Shoichi (Department of Orthopedic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto (Japan))

    2012-02-15

    Background. Reports on CT-guided percutaneous drainage within the intervertebral space for pyogenic spondylodiscitis with a secondary psoas abscess are limited. Purpose. To evaluate CT-guided percutaneous drainage within the intervertebral space for pyogenic spondylodiscitis and a secondary psoas abscess in which the two sites appear to communicate. Material and Methods. Eight patients with pyogenic spondylodiscitis and a secondary psoas abscess showing communication with the intradiscal abscess underwent CT-guided percutaneous drainage within the intervertebral space. The clinical outcome was retrospectively assessed. Results. An 8-French pigtail catheter within the intervertebral space was successfully placed in all patients. Seven patients responded well to this treatment. The one remaining patient who had developed septic shock before the procedure died on the following day. The mean duration of drainage was 32 days (13-70 days). Only one patient with persistent back pain underwent surgery for stabilization of the spine after the improvement of inflammation. Among seven patients responding well, long-term follow-up (91-801 days, mean 292 days) was conducted in six patients excluding one patient who died of asphyxiation due to aspiration unrelated to the procedure within 30 days after the procedure. In these six patients, no recurrence of either pyogenic spondylodiscitis or the psoas abscess was noted. Conclusion. CT-guided percutaneous drainage within the intervertebral space can be effective for patients with pyogenic spondylodiscitis and a secondary psoas abscess if the psoas abscess communicates with the intradiscal abscess

  2. Therapeutic impact of CT-guided percutaneous catheter drainage in treatment of deep tissue abscesses.

    Science.gov (United States)

    Asai, Nobuhiro; Ohkuni, Yoshihiro; Yamazaki, Ikuo; Kaneko, Norihiro; Aoshima, Masahiro; Kawamura, Yasutaka

    2013-01-01

    Combination therapy of CT-guided percutaneous drainage and antibiotics is the first-line treatment for abscesses. Its effectiveness has been demonstrated. However, the therapeutic impact of this procedure for infection treatment has never been reported. We retrospectively analyzed all 47 patients who received CT-guided percutaneous drainage for infection treatment. Patients' characteristics, pathogens isolated, antibiotics administered, technical and clinical outcomes, complications related to this procedure and therapeutic impacts were investigated. Patients were 26 males and 21 females. The mean age was 63.5 years (±18.7). The diseases targeted were 19 retroperitoneal abscesses, 18 intra-abdominal abscesses, three pelvic abscesses, and seven others. As for technical outcomes, all of the 54 procedures (100%) were successful. As for clinical outcomes, 44 (93.6%) were cured and three patients (6.4%) died. No complications related to this procedure were found in this study. A total of 42 patients (88%) had a change in the management of their infection as a result of CT-guided percutaneous drainage, such as selection and discontinuation of antibiotics. In conclusion, CT-guided percutaneous drainage is a safe and favorable procedure in the treatment of deep tissue abscesses. Therapeutic impact of these procedures helped physicians make a rational decision for antibiotics selection.

  3. Obscure gastrointestinal bleeding: preoperative CT-guided percutaneous needle localization of the bleeding small bowel segment.

    Science.gov (United States)

    Heiss, Peter; Feuerbach, Stefan; Iesalnieks, Igors; Rockmann, Felix; Wrede, Christian E; Zorger, Niels; Schlitt, Hans J; Schölmerich, Jürgen; Hamer, Okka W

    2009-04-01

    A 57-year-old woman presented with obscure gastrointestinal bleeding. Double balloon enteroscopy, angiography, and surgery including intraoperative enteroscopy failed to identify the bleeding site. Multidetector computed tomography (CT) depicted active bleeding of a small bowel segment. The bleeding segment was localized by CT-guided percutaneous needle insertion and subsequently removed surgically.

  4. CT-guided percutaneous laser photocoagulation of osteoid osteomas of the hands and feet

    Energy Technology Data Exchange (ETDEWEB)

    Zouari, Leila; Bousson, Valerie; Hamze, Bassam; Roqueplan, Francois; Laredo, Jean-Denis [Hopital Lariboisiere, Service de Radiologie Osteo-Articulaire, Paris (France); Roulot, Eric [Clinique Jouvenet, Institut de la main, Paris (France)

    2008-11-15

    Percutaneous local ablation of osteoid osteoma has largely replaced surgery, except in the small bones of the hands and feet. The objective of this study was to describe the technical specificities and results of computed tomography (CT)-guided percutaneous laser photocoagulation in 15 patients with osteoid osteomas of the hands and feet. We retrospectively examined the medical charts of the 15 patients who were treated with CT-guided percutaneous laser photocoagulation therapy at our institution between 1994 and 2004. The 15 patients had a mean age of 24.33 years. None of them had received any prior surgical or percutaneous treatment for the osteoid osteoma. The follow-up period was 24 to 96 months (mean, 49.93). The pain resolved completely within 1 week. Fourteen patients remained symptom-free throughout the follow-up period; the remaining patient experienced a recurrence of pain after 24 months, underwent a second laser photocoagulation procedure, and was symptom-free at last follow-up 45 months later. No adverse events related to the procedure or to the location of the tumor in the hand or the foot were recorded. CT-guided percutaneous laser photocoagulation is an alternative to surgery for the treatment of osteoid osteomas of the hands and feet. (orig.)

  5. Percutaneous CT-guided cryoablation for the treatment of refractory pudendal neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Prologo, J.D.; Williams, Roger [Emory University Hospital, Department of Radiology and Imaging Sciences Division of Interventional Radiology and Image-Guided Medicine, Atlanta, GA (United States); Lin, Roger C. [University Hospitals Case Medical Center, Department of Radiology, Cleveland, OH (United States); Corn, David [Case Western Reserve University, Department of Biomedical Engineering, Cleveland, OH (United States)

    2015-05-01

    To evaluate the safety and efficacy of percutaneous CT-guided cryoablation of the pudendal nerve for the treatment of refractory pudendal neuralgia. Eleven patients were selected to undergo percutaneous CT-guided cryoablation of the pudendal nerve based on established diagnostic criteria. Brief Pain Inventory questionnaires were administered prior to the procedure, during the immediate 24 h post procedure, and 45 days and 6 months following the procedure. Prior to treatment, the average level of pain on a scale from 0 (no pain) to 10 (worst pain imaginable) was 7.6, with pain described as ''burning'' (80%), ''pulling'' (37.5%), ''crushing'' (50%), ''pressure'' (84.5%), ''throbbing'' (50%), ''knife-life'' (52%), and ''other'' (60%). At 24 h, 45 days, and 6 months post-treatment, pain intensity dropped to 2.6, 3.5, and 3.1, respectively (p < 0.005). There were no procedure-related complications. CT-guided percutaneous cryoablation may represent a safe and efficacious option for selected patients with refractory pudendal neuralgia. (orig.)

  6. Percutaneous treatment of osteoid osteoma by CT-guided drilling resection in pediatric patients

    Energy Technology Data Exchange (ETDEWEB)

    Sierre, Sergio; Lipsich, Jose; Questa, Horacio; Moguillansky, Silvia [Hospital Nacional de Pediatria, Department of Interventional Radiology, Buenos Aires (Argentina); Innocenti, Sergio; Lanfranchi, Lucas [Hospital Nacional de Pediatria, Department of Orthopedics, Buenos Aires (Argentina)

    2006-02-01

    Osteoid osteoma is a painful, benign, small osteogenic bone tumor. For a long time, surgery was the only treatment for these lesions. Different minimally invasive therapeutic techniques have been proposed. We report our experience in the treatment of osteoid osteoma by CT-guided drilling resection in pediatric patients. To evaluate the efficacy of CT-guided percutaneous drilling resection as a minimally invasive therapy for osteoid osteoma in children. Over a 5-year period, 18 patients (age range 6-17 years, mean age 11.6 years) with osteoid osteomas (femur, n=10; tibia, n=5; humerus, n=2; vertebral body, n=1) were treated with this technique. All procedures were performed under general anesthesia. All procedures were technically successful. Clinical success was achieved in 94.5% of patients (17/18). Only one patient had recurrence of symptoms 8 months after percutaneous resection and was surgically retreated. There were no complications. CT-guided percutaneous drilling resection is a safe, simple and effective minimally invasive technique for the treatment of osteoid osteoma in pediatric patients. (orig.)

  7. Diagnostic usefulness of CT-guided percutaneous biopsy of the spine

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Kyung Jin; Kim, Won Hong; Byun, Joon Soo; Cho, Young Kook; Cho, Kyu Jung; Moon, Kyung Ho; Seok, Eul Hye; Shin, Seok Hwan; Han, Heon [Inha Univ. College of Medicine, Inchon (Korea, Republic of)

    1999-12-01

    To evaluate the diagnostic value of CT-guided percutaneous biopsy of inflammatory and tumorous lesions of the spine and paraspinal soft tissue. Twenty-three patients underwent CT-guided percutaneous biopsy of the spine and paraspinal soft tissue. Tentative clinical diagnoses determined before biopsy were tuberculous spondylitis(n=5), pyogenic spondylitis (n=4), butterfly vertebra (n=1), old compression fracture (n=3), discitis (n=1), hemangioma (n=1), metastasis (n=7) and multiple myeloma (n=1). Biopsy was performed at the following levels: cervical-(n=1), thoracic-(n=9), and lumbar-spine(n=13). The approach to biopsy of the spine and paraspinal soft tissue lesions was posterolateral (n=11), posterior (n=2), or transpedicular (n=10). Tissue considered adequate by the pathologist involved was obtained in 21 (91%) of the 23 cases. In 19 cases, pathologic findings supported the clinical diagnoses determined before biopsy. In two cases, pathologic and clinical diagnoses differed. Complications such as severe pain, bleeding, infection, neurologic deficit or damage to internal organs were detected neither during or after the procedure. CT-guided percutaneous biopsy is a safe and reliable method of obtaining a diagnosis in many cases involving different spinal and paraspinal lesions.

  8. Therapeutic outcome of CT-guided radiofrequency ablation in patients with osteoid osteoma

    Energy Technology Data Exchange (ETDEWEB)

    Lassalle, Louis; Campagna, R.; Corcos, G.; Feydy, A. [Hopital Cochin-APHP Paris Universite Paris Descartes, Service de Radiologie Osteo-Articulaire, Paris (France); Babinet, A. [Hopital Cochin-APHP Paris Universite Paris Descartes, Service de Chirurgie Orthopedique, Paris (France); Larousserie, F. [Hopital Cochin-APHP Paris Universite Paris Descartes, Service d' Anatomo-Pathologie, Paris (France); Stephanazzi, J. [Hopital Cochin-APHP Paris Universite Paris Descartes, Service d' Anesthesie, Paris (France)

    2017-07-15

    To assess the long-term outcome of computed tomography-guided radiofrequency ablation (CT-guided RFA) in patients with suspected osteoid osteoma (OO). Single-center retrospective study. Patients with clinical suspicion and imaging diagnosis of osteoid osteoma were treated by CT-guided RFA using the same device with either a 7- or 10-mm active tip electrode. Specific precautions were applied in case of articular or spinal OO. Patients were contacted by phone to evaluate the long-term outcome in terms of pain, ability to perform daily activities (including sports), and long-term complications. Success was defined as the absence of residual pain and ability to perform daily activities normally. From 2008 to 2015, 126 patients were treated by CT-guided RFA for OO in our institution. Mean patient age was 26.1 years (SD = 11, range 1-53); mean delay to diagnosis was 16.9 months (SD = 15.2, range 1-120). Among patients who answered the follow-up call (n = 88), the overall success rate was 94.3%: 79/88 (89.8%) had primary success of the procedure, and 4/88 (4.5%) had a secondary success (repeat-RFA after pain recurrence). Mean follow-up time was 34.6 months (SD = 24.7, range 3-90). Few complications occurred: two mild reversible peripheral nerve injuries, one brachial plexus neuropathy, one broken electrode tip fragment, and one muscular hematoma. Osteoid osteoma can be effectively and safely treated by CT-guided RFA using the presented ablation protocol. Beneficial effects of the treatment persist at long-term follow-up. (orig.)

  9. CT-guided percutaneous spine biopsy in suspected infection or malignancy. A study of 214 patients

    Energy Technology Data Exchange (ETDEWEB)

    Rehm, J.; Veith, S.; Kauczor, H.U.; Weber, M.A. [Heidelberg Univ. (Germany). Inst. of Diagnostic and Interventional Radiology; Akbar, M. [Heidelberg Univ. (Germany). Dept. of Orthopaedic Surgery and Rehabilitation Medicine

    2016-12-15

    To retrospectively determine the effectiveness and accuracy of CT-guided percutaneous biopsy of malignant and inflammatory bone lesions of the spine and to assess the reliability of pre-biopsy CT and MRI. 214 patients with lesions of the spine, which were suspicious either for being malignant or inflammatory, underwent CT-guided biopsy for pathological and/or microbiological detection. Biopsy samples were sent for histological examination in 128/214 patients, for microbiological analysis in 17/214 patients and for both analyses in 69/214 patients. Retrospectively, the diagnostic accuracy and sensitivity/specificity of the pre-interventional imaging (CT and MRI) were determined. In addition, the influence of the biopsy on subsequent patient management was assessed. The accuracy was 94.4% for histopathological analysis and 97.7% for microbiological analysis. In 25% of cases the microbiological analysis revealed an underlying pathogen that was not significantly affected by pre-biopsy antibiotic therapy. The sensitivity/specificity of the pre-biopsy cross-sectional imaging concerning suspected malignancy was 69%/78%. For suspected infection, the sensitivity/specificity of pre-biopsy imaging was 81%/44%. In 52% of all cases, the biopsy result changed subsequent patient management. Percutaneous CT-guided spine biopsy is a useful and reliable diagnostic procedure to establish a definitive diagnosis but with a relatively low yield of microorganisms in the case of infection.

  10. Efficacy and Safety of CT Guided Percutaneous Radiofrequency Thermocoagulation in the Treatment of Recurrent Trigeminal Neuralgia After Other Surgical Treatment%CT 引导下经皮三叉神经半月节射频热凝术治疗其他术式术后复发三叉神经痛的疗效及安全性分析

    Institute of Scientific and Technical Information of China (English)

    杨惠婕; 唐元章; 倪家骧

    2016-01-01

    目的:探讨 CT 引导下经皮三叉神经半月节射频热凝术(PRT)治疗其他术式术后复发三叉神经痛的临床疗效及安全性。方法选取2002—2013年首都医科大学宣武医院疼痛科收治的采用 CT 引导下 PRT 治疗其他术式术后复发三叉神经痛的88例患者的临床资料。采用巴罗神经学研究所(BNI)分级评定标准评定患者临床疗效(疼痛缓解、疼痛未缓解)。记录患者术后并发症:面部麻木、咀嚼力下降、角膜炎、复视、脑脊液漏、死亡等。采用生存分析中的 Kaplan - Meier 法计算患者术后1、2、5、10年疼痛缓解率。结果本组88例患者均成功行 CT 引导下 PRT。83例(94.3%)患者术后疼痛缓解,5例(5.7%)患者术后疼痛未缓解。88例患者术后1年疼痛缓解率为83.0%,术后2年疼痛缓解率为75.0%,术后5年疼痛缓解率为59.0%,术后10年疼痛缓解率为49.0%。76例(93.8%)患者在随访期间存在持续麻木;咀嚼肌力下降8例(9.1%);角膜炎4例(4.5%),其中三叉神经第一支受累1例、三叉神经三支均受累3例,采用人工泪液滴眼后症状缓解;无复视、脑脊液漏等严重并发症发生;无因 CT 引导下 PRT 死亡患者。结论 CT 引导下 PRT 治疗其他术式术后复发三叉神经痛安全、有效,值得临床借鉴。%Objective To investigate the efficacy and safety of CT guided percutaneous radiofrequency thermocoagulation(PRT)in the treatment of recurrent trigeminal neuralgia after other surgical treatment. Methods From 2002 to 2013,we collected the clinical data of 88 patients with recurrent trigeminal neuralgia after other surgical treatment who were treated through CT guided PRT in Department of Pain Management,Xuanwu Hospital Capital Medical University. The clinical efficacy(pain remission and no pain remission)was evaluated using the grading scale of Barrow Neurological Institute(BNI). Postoperative

  11. Percutaneous CT-guided biopsy of the musculoskeletal system: Results of 2027 cases

    Energy Technology Data Exchange (ETDEWEB)

    Rimondi, Eugenio, E-mail: eugenio.rimondi@ior.it [Radiology Department, Istituto Ortopedico Rizzoli, Bologna (Italy); Rossi, Giuseppe [Interventional Angiography Department, Istituto Ortopedico Rizzoli, Bologna (Italy); Bartalena, Tommaso [Radiology Department, University of Bologna (Italy); Ciminari, Rosanna [Radiology Department, Istituto Ortopedico Rizzoli, Bologna (Italy); Alberghini, Marco [Surgical Pathology Department, Istituto Ortopedico Rizzoli, Bologna (Italy); Ruggieri, Pietro; Errani, Costantino; Angelini, Andrea; Calabro, Teresa; Abati, Caterina Novella [Orthopaedic Oncology Department, Istituto Ortopedico Rizzoli, Bologna (Italy); Balladelli, Alba [Laboratory of Experimental Oncology, Istituto Ortopedico Rizzoli, Bologna (Italy); Tranfaglia, Cristina [Nuclear Medicine Department, Maggiore Hospital, Bologna (Italy); Mavrogenis, Andreas F. [Orthopaedic Oncology Department, Istituto Ortopedico Rizzoli, Bologna (Italy); Vanel, Daniel [Bone Tumor Center, Istituto Ortopedico Rizzoli, Bologna (Italy); Mercuri, Mario [Orthopaedic Oncology Department, Istituto Ortopedico Rizzoli, Bologna (Italy)

    2011-01-15

    Introduction: Biopsy of the musculoskeletal system is useful in the management of bone lesions particularly in oncology but they are often challenging procedures with a significant risk of complications. Computed tomography (CT)-guided needle biopsies may decrease these risks but doubts still exist about their diagnostic accuracy. This retrospective analysis of the experience of a single institution with percutaneous CT-guided biopsy of musculoskeletal lesions evaluates the results of these biopsies for bone lesions either in the appendicular skeleton or in the spine, and defines indications. Materials and methods: We reviewed the results of 2027 core needle biopsies performed over the past 18 years at the authors' institution. The results obtained are subject of this paper. Results: In 1567 cases the correct diagnosis was made with the first CT-guided needle biopsy (77.3% accuracy rate), in 408 cases the sample was not diagnostic and in 52 inadequate. Within 30 days these 408 patients underwent another biopsy, which was diagnostic in 340 cases with a final diagnostic accuracy of 94%. Highest accuracy rates were obtained in primary and secondary malignant lesions. Most false negative results were found in cervical lesions and in benign, pseudotumoral, flogistic, and systemic pathologies. There were 22 complications (18 transient paresis, 3 haematomas, 1 retroperitoneal haematoma) which had no influence on the treatment strategy, nor on patient outcome. Conclusion: This technique is reliable and safe and should be considered nowadays the gold standard for biopsies of the musculoskeletal system.

  12. Percutaneous CT guided bone biopsy in patients with suspected bone neoplasm

    Energy Technology Data Exchange (ETDEWEB)

    Yasui, Kotaro; Kanazawa, Susumu; Tanaka, Akio; Hiraki, Yoshio [Okayama Univ. (Japan). School of Medicine

    1996-03-01

    Bone biopsy is necessary for the diagnosis of ambiguous, skeletal lesions. Although several merits of computed tomography (CT)-guided percutaneous needle biopsy have been documented, few radiologists have performed this procedure in Japan. We performed this procedure with a newly introduced bone biopsy needle (OSTYCUT, angiomed, Karlsruhe, Germany) under CT guidance and evaluated the results. CT-guided bone biopsy (pelvic [n=11] vertebral [n=10], femoral [n=1], stemal [n=1]) was performed in 19 consecutive patients. Seventeen patients were suspected metastatic disease, and the others were suspected primary bone tumor. All biopsies but one were diagnostic. Malignancy was proved in 11 lesions. Three patients with prostatic carcinoma were proved to show no malignancy of bone lesions after a series of hormonal and chemotherapies. In one patient with both malignant mesothelioma and cervical carcinoma, the biopsy specimen from thoracic vertebra proved metastasis from mesothelioma. CT-guided bone biopsy is useful to evaluate the presence of malignancy and the effect of therapy for it, and to determine the primary site. (author).

  13. CT-Guided Percutaneous Radiologic Gastrostomy for Patients with Head and Neck Cancer: A Retrospective Evaluation in 177 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Tamura, Akio, E-mail: a.akahane@gmail.com; Kato, Kenichi, E-mail: kkato@iwate-med.ac.jp; Suzuki, Michiko, E-mail: mamimichiko@me.com [Iwate Medical University School of Medicine, Department of Radiology (Japan); Sone, Miyuki, E-mail: msone@me.com [National Cancer Center Hospital, Department of Diagnostic Radiology (Japan); Tanaka, Ryoichi, E-mail: rtanaka@iwate-med.ac.jp; Nakasato, Tatsuhiko, E-mail: nakasato@iwate-med.ac.jp; Ehara, Shigeru, E-mail: ehara@iwate-med.ac.jp [Iwate Medical University School of Medicine, Department of Radiology (Japan)

    2016-02-15

    PurposeThe purpose of this study was to assess the technical success rate and adverse events (AEs) associated with computed tomography (CT)-guided percutaneous gastrostomy for patients with head and neck cancer (HNC).Materials and MethodsThis retrospective study included patients with HNC who had undergone CT-guided percutaneous gastrostomy between February 2007 and December 2013. Information regarding the patients’ backgrounds, CT-guided percutaneous gastrostomy techniques, technical success rate, and AEs were obtained from the medical records. In all patients, the stomach was punctured under CT fluoroscopy with a Funada gastropexy device.ResultsDuring the study period, 177 patients underwent CT-guided percutaneous gastrostomy. The most common tumor location was the oral cavity, followed by the pharynx and maxilla. The indication for CT-guided percutaneous gastrostomy were tumor obstruction in 78 patients, postoperative dysphagia in 55 patients, radiation edema in 43 patients, and cerebral infarction in 1 patient. The technical success rate was 97.7 %. The overall mean procedure time was 25.3 min. Major AEs occurred in seven patients (4.0 %), including bleeding (n = 4), colonic injury (n = 1), gastric tear (n = 1), and aspiration pneumonia (n = 1). Minor AEs occurred in 15 patients (8.5 %), which included peristomal leakage (n = 6), irritation (n = 4), inadvertent removal (n = 2), peristomal hemorrhage (n = 1), peristomal infection (n = 1), and wound granulation (n = 1). The mean follow-up period was 111 days (range 1–1106 days).ConclusionOur study suggests that CT-guided gastrostomy may be suitable in patients with HNC.

  14. Treatment of aneurysmal bone cysts by percutaneous CT-guided injection of calcitonin and steroid

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Connie Y.; Kattapuram, Susan V.; Huang, Ambrose J.; Simeone, F.J.; Torriani, Martin; Bredella, Miriam A. [Massachusetts General Hospital, Department of Radiology Division of Musculoskeletal Imaging and Intervention, Boston, MA (United States)

    2017-01-15

    To determine the efficacy and safety of percutaneous calcitonin and steroid injection in the treatment of aneurysmal bone cysts (ABCs). Our study was IRB-approved and HIPAA-compliant. We reviewed pre- and post-procedural imaging studies and medical records of all CT-guided percutaneous injections of ABCs with calcitonin and steroid performed at our institution between 2003 and 2015. Treatment success based on imaging was categorized as substantial (51-100 %), partial (1-50 %), or none (0 %) by comparing radiographs of the lesion before and after treatment. Our study group comprised 9 patients (7 female, 2 male; mean age 19 ± 5 (range 12-25) years). ABCs were located in the pubis (n = 3), femur (n = 2), and humerus/scapula/ilium/sacrum (n = 1 for each). One patient did not have any clinical or imaging follow-up. For the other 8 patients, clinical and imaging follow-up ranged from 1 to 93 months (mean 16 ± 29 months). One patient had two injections, and 1 patient had three injections. Six out of eight patients (75 %) had complete symptomatic relief and 2 patients (25 %) had partial symptomatic relief after initial injection. Imaging follow-up revealed substantial imaging response in 4 out of 8 patients (50 %). There was a partial imaging response in 2 patients (25 %) and no imaging response in 2 out of 8 patients (25 %), and all 4 of these patients had local recurrence. There were no complications. Percutaneous CT-guided injection of ABCs with calcitonin and steroid is a safe and effective treatment. Lack of imaging response may necessitate more aggressive treatment to minimize local recurrence. (orig.)

  15. CT-guided percutaneous cryoablation of osteoid osteoma in children: an initial study

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    Wu, Bin; Xiao, Yue-Yong; Zhang, Xiao [Chinese PLA General Hospital, Department of Radiology, Beijing (China); Zhao, Lei [Brigham and Women' s Hospital, Harvard Medical School, Department of Radiology, Boston, MA (United States); Carrino, John A. [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States)

    2011-10-15

    The purpose of this study was to evaluate the safety and efficacy of CT-guided percutaneous cryoablation for osteoid osteoma in children. This study was approved by the institutional ethics committee. From January 2007 to July 2008, six children (four boys, two girls, mean age 12.6 years old) with osteoid osteoma were treated with CT-guided percutaneous cryoablation. The procedures were carried out under conscious sedation and local anesthesia. CT guidance was used for procedural planning, instrument guidance, and monitoring. An argon-based cryoablation system was used. Each cryoablation included two freezing-thawing cycles. Follow-up was performed to assess technical and clinical outcome for a minimum of 12 months. A visual analog scale (VAS) was used to assess severity of pain pre- and post-procedure, and mean VAS for the group was compared pre- and post-procedure with a t-test. The mean clinical follow-up period was 28.7 months (ranging from 18 to 36 months). Cryoablation was technically and clinically successful for all patients. No major immediate or delayed complications were observed. Significant pain relief (P <0.05) was observed in all patients after operation. Mean VAS were 6.57 {+-} 0.55 pre-procedure and 0.57 {+-} 0.10 1 month post-procedure. Patients were allowed to fully bear their weight and function without limitation within 3 days after the procedure. Pain recurrence was not observed in any patient. Percutaneous cryoablation is safe and effective for the treatment of osteoid osteomas in children. Notably, this procedure can be accomplished without general anesthesia. (orig.)

  16. CT-guided radiofrequency ablation of osteoid osteoma using a novel battery-powered drill

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    Schnapauff, Dirk; Streitparth, Florian; Wieners, Gero; Collettini, Federico; Hamm, Bernd; Gebauer, Bernhard [Charite Universitaetsmedizin Berlin, Department of Radiology, Berlin (Germany); Joehrens, Korinna [Charite Universitaetsmedizin Berlin, Department of Pathology, Berlin (Germany)

    2015-05-01

    To evaluate the use of a novel battery-powered drill, enabling specimen requirement while drilling, in radiofrequency ablation of osteoid osteoma as an alternative to conventional orthopedic drills. Between 2009 and 2013, altogether 33 patients underwent CT-guided radiofrequency ablation of an osteoid osteoma at our institution. To access the nidus of the clinically and radiologically suspected osteoid osteoma, a channel was drilled using the OnControl Bone Marrow Biopsy System (OBM, Arrow OnControl, Teleflex, Shavano Park, TX, USA) and a biopsy was taken. Procedure time (i.e., drilling including local anesthesia), amount of scans (i.e., single-shot fluoroscopy), radiation exposure, and the results of biopsy were investigated and compared retrospectively to a classical approach using either a manual bone biopsy system or a conventional orthopedic drill (n = 10) after ethical review board approval. Drilling the tract into the nidus was performed without problems in 22 of the 23 OBM cases. Median procedure time was 7 min compared to 13 min using the classical approach (p < 0.001). Median amount CT scans, performed to control correct positioning of the drill was comparable with 26 compared to 24.5 (p = NS) scans. Histologically, the diagnosis of osteoid osteomas could be determined in all 17 cases where a biopsy was taken. Radiofrequency ablation could be performed without problems in any case. The use of the battery-powered drill was feasible and facilitated the access to the osteoid osteoma's nidus offering the possibility to extract a specimen in the same step. (orig.)

  17. Percutaneous radiofrequency ablation in painful bone metastases

    Directory of Open Access Journals (Sweden)

    German Garabano

    2015-09-01

    Full Text Available Backgraund There are different treatment for painful bone metastases (mtts, with different results. CT-guided Percutaneous Radiofrequency Ablation (CT-PRA is one of them. The pupose of this retrospective study was to assess the initial results using this methods, focusing on pain relief, showing details of the surgical technique. Methods 18 patients with an average age of 59.2 years and 15 months follow-up were treated. Nine mtts were located in the femur, 4 dorsal / lumbar spine, 3 in scapula and 2 in Iliac. The Mtts origin were Breast Ca 7 cases, lung in 4, Kidney in 4 and 3 in Thyroid. The rachis mtts were found at more than 10mm of the medullary cavity and mtts of long bones showed low risk of fracture. Lesions >3cm were treated whit CT-PRA  using Valleylab Rita needle and these <3cm with CoolTip needle. Pain was assessed by Visual Analog Scale (VAS preoperatively, at 2, 7 and 30 days, and then at 3 and 6 months. Results Preoperative pain score was 8.33 on average. At 7 days of ablatión de VAS score was 5 on average and at 30 days was 2 points. After at 3 and 6 months de VAS average was 1. This method had excellent patients tolerance and no complications. There were two recurrences which underwent endoprosthesis unconventional proximal femur and knee respectively, evolving favorably. Conclusion CT-guided APRF impresses a promising, simple and effective tool in the treatment of painfull bone mtts, achieving excellent pain control with good tolerance by the patient.

  18. Improved outcomes with direct percutaneous CT guided lumbar synovial cyst treatment: advanced approaches and techniques.

    Science.gov (United States)

    Ortiz, A Orlando; Tekchandani, Leena

    2014-12-01

    To determine if lumbar synovial cyst rupture in symptomatic patients results in improved clinical outcome when using direct tandem and/or coaxial percutaneous CT guided techniques. 20 patients with unilateral lower extremity radiculopathy and/or low back pain underwent CT guided percutaneous treatment for their symptomatic lumbar synovial cysts. Cysts were identified with the use of a low osmolar non-ionic contrast agent via facet joint injection or through direct injection. Cyst rupture, using a direct tandem and/or coaxial technique, was attempted in all patients using an 18 gauge guide needle and a 22 gauge insert needle. Following attempted cyst aspiration, cyst rupture was performed using 1-3 mL of a mixture of methylprednisolone (2 mL, 80 mg) and bupivacaine (3 mL, 0.5%). All patients were followed-up in clinic for a minimum of 6 months after their procedures and up to a maximum of 24 months. 11 patients were male and nine were female, with an average age of 65.6 years. 17 patients presented with severe unilateral lower extremity radiculopathy and three patients were experiencing low back pain. One of the patients had two synovial cysts, and therefore a total of 21 lumbar synovial cysts were treated in this group of patients. Direct cyst puncture was achieved using a tandem technique in nine patients, a coaxial interlaminar approach in seven patients, a coaxial transforaminal approach in two patients, and a coaxial trans-facet approach in three patients. Cyst rupture was documented in all cases, as evidenced by CT confirmation of cyst decompression and contrast agent extravasation into the epidural space. The mean surveillance period in these patients was 18 months. Six patients experienced their usual radicular pain within 2 months of their treatment. Four of these patients were re-treated for recurrent smaller cysts. These patients have not had a recurrence at 24 months of follow up. Two of these six patients elected to undergo open

  19. CT-Guided Radiofrequency Ablation of T1a Renal Cell Carcinoma in Korea: Mid-Term Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hae Jin; Park, Byung Kwan; Park, Jung Jae; Kim, Chan Kyo [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351 (Korea, Republic of)

    2016-11-01

    To evaluate the mid-term outcomes of percutaneous radiofrequency ablation (RFA) treatment in patients with small (< 4 cm) renal cell carcinoma (RCC) in Korea. Between 2010 and 2015, 51 patients (40 men and 11 women; median age, 57 years) with biopsyproven 51 RCC were treated using CT-guided RFA. All patients were clinically staged T1aN0M0 prior to RFA. The median tumor size and follow-up period were 2.1 cm (range, 1.0–3.9 cm) and 26 months (4–60 months), respectively. Local tumor progression, distant metastasis, primary and secondary effectiveness rates, and major complication rates were recorded. Estimated glomerular filtration rates (GFRs) between pre-RFA and last follow-up were compared using paired t tests. The 2-year recurrence-free survival rate was calculated using Kaplan-Meier survival analysis. Of the 51 patients, 2 (3.9%) experienced local tumor progression, and 1 (2.0%) had lymph node metastasis after the first RFA session. Primary and secondary effectiveness rates were 96.1% (49/51) and 100% (1/1), respectively. Only 1 patient experienced a major complication (uretero-pelvic stricture) after the second RFA session for treating a local tumor progression, and the major complication rate was 1.9% (1/52). The median pre-RFA and last follow-up GFRs were 87.1 mL/ min/1.73 m{sup 2} (14.2–142.7 mL/min/1.73 m{sup 2}) and 72.0 mL/min/1.73 m{sup 2} (7.2–112.6 mL/min/1.73 m{sup 2}), respectively (p < 0.0001). The 2-year recurrence-free survival rate was 96.0%. CT-guided RFA is a safe and effective treatment in Korean patients with T1a RCC because of excellent mid-term outcomes.

  20. CT-guided radiofrequency ablation of T1a renal cell carcinma in Korea; Mid-erm outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hae Jin; Park, Byung Kwan; Park, Jung Jae; Kim, Chan Kyo [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2016-09-15

    To evaluate the mid-term outcomes of percutaneous radiofrequency ablation (RFA) treatment in patients with small (< 4 cm) renal cell carcinoma (RCC) in Korea. Between 2010 and 2015, 51 patients (40 men and 11 women; median age, 57 years) with biopsyproven 51 RCC were treated using CT-guided RFA. All patients were clinically staged T1aN0M0 prior to RFA. The median tumor size and follow-up period were 2.1 cm (range, 1.0–3.9 cm) and 26 months (4–60 months), respectively. Local tumor progression, distant metastasis, primary and secondary effectiveness rates, and major complication rates were recorded. Estimated glomerular filtration rates (GFRs) between pre-RFA and last follow-up were compared using paired t tests. The 2-year recurrence-free survival rate was calculated using Kaplan-Meier survival analysis. Of the 51 patients, 2 (3.9%) experienced local tumor progression, and 1 (2.0%) had lymph node metastasis after the first RFA session. Primary and secondary effectiveness rates were 96.1% (49/51) and 100% (1/1), respectively. Only 1 patient experienced a major complication (uretero-pelvic stricture) after the second RFA session for treating a local tumor progression, and the major complication rate was 1.9% (1/52). The median pre-RFA and last follow-up GFRs were 87.1 mL/ min/1.73 m{sup 2} (14.2–142.7 mL/min/1.73 m{sup 2}) and 72.0 mL/min/1.73 m{sup 2} (7.2–112.6 mL/min/1.73 m{sup 2}), respectively (p < 0.0001). The 2-year recurrence-free survival rate was 96.0%. CT-guided RFA is a safe and effective treatment in Korean patients with T1a RCC because of excellent mid-term outcomes.

  1. Single incision laparoscopic surgery approach for obscure small intestine bleeding localized by CT guided percutaneous injection of methylene blue

    Directory of Open Access Journals (Sweden)

    Juan Carlos Martinez

    2014-01-01

    PRESENTATION OF CASE: We present a new technique used in a patient with angiodysplasia of the small intestine, in where preoperative localization was done using percutaneous computed tomography (CT guided injection of methylene blue dye. This allowed us to perform a single incision laparoscopic small intestine resection of the culprit.

  2. Successful percutaneous CT-guided microwave ablation of adrenal gland for ectopic Cushing syndrome.

    Science.gov (United States)

    Zener, Rebecca; Zaleski, Andrew; Van Uum, Stan H; Gray, Daryl K; Mujoomdar, Amol

    Adrenocorticotropic hormone production by pancreatic neuroendocrine tumor (PNET) is rare and results in hyperstimulation of the adrenal gland to produce ectopic Cushing syndrome. Our case showcases the safety and effectiveness of percutaneous CT-guided microwave ablation of the adrenal gland in a 49-year-old female with PNET and hepatic metastases who presented with ectopic Cushing syndrome despite surgical resection of the primary pancreatic tumor and left adrenal gland. Prior to ablation, the right adrenal gland measured 4.3×1.6×2.0cm and the patient had malignant hypertension with elevated morning serum cortisol level (1976nmol/L). After microwave ablation of the right adrenal gland, the hypertension resolved and the cortisol level decreased dramatically (74nmol/L). As expected after successful treatment, the patient developed adrenal insufficiency and was placed on glucocorticoid and mineralocorticoid supplementation. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Percutaneous CT-guided catheter drainage of intrathoracic fluid collections. Perkutane CT-gefuehrte Katheterdrainage intrathorakaler Fluessigkeitsansammlungen

    Energy Technology Data Exchange (ETDEWEB)

    Barton, P.; Schurawitzki, H.; Karnel, F. (Universitaetsklinik, Vienna (Austria). Radiodiagnostik); Klepetko, W. (Ludwig-Boltzmann Inst. fuer Radiologisch-Physikalische Tumordiagnostik, Vienna (Austria). 2. Chirurgische Universitaetsklinik)

    1992-01-01

    To verify the value of percutaneous CT-guided drainage of thoracic fluid collections we studied the outcome in 39 patients retrospectively. 24 (61.5%) of the fluid collections were located in the pleural space 10 (25.6%) in the lungs and 5 (12.8%) in the mediastinum. 11 CT-guided drainages after a previous attempt were necessary in 9 patients, because of recurrent Cn = 6 or residual (n = 5) fluid collections. 80% of the drainage procedures were done using Seldinger's, 30% using trocar technique, mainly with 8.3 - 12 F catheters. The mean duration of drainage was 10.7 days. In 28 patients (71.8%) the percutaneous CT-guided drainage was curative. In 9 cases (23.1%) the patient's course was stabilised and surgery could be applied electively. 2 patients (5.1%) died because of their underlying endstage malignancy. None of the drainage procedures changed the patient's course to the worse. There was only 1 pneumothorax with no need of any treatment; no other complication occurred. Our results suggest that percutaneous CT-guided drainage of thoracic fluid collections is a safe and straightforward alternative to surgical treatment. (orig.).

  4. CT-guided Percutaneous Interventional Treatment for the Lumbar Disc Hernia%CT引导介入治疗腰椎间盘突出症

    Institute of Scientific and Technical Information of China (English)

    曾庭基; 许国增

    2015-01-01

    目的:探讨CT引导射频结合胶原酶介入治疗腰椎间盘突出症的临床应用价值。方法对48例临床诊断为腰椎间盘突出症、经CT检查证实的患者进行CT导引下射频联合胶原酶介入治疗,全部病例进行突出物内射频热凝和突出物内注射0.45 ml 275 U 胶原酶,其中L4/5椎间盘病变23例,L5/S1椎间盘病变25例。结果穿刺成功率100%,6个月后随访,腰椎间盘突出症状缓解情况:优25例、良20例、可3例、差0例。CT复查突出物明显变小26例,部分变小22例。本研究过程未出现过敏反应、神经根损伤等并发症。结论 CT引导介入治疗是腰椎间盘突出症的有效治疗方法。%Objective To investigate the clinical value of CT-guided percutaneous radiofrequency combined with collagenase treatment for lumbar disc hernia.Methods A total of 48 patients with lumbar disc hernia diagnosed by clinic and CT accepted CT-guided percutaneous radiofrequency combined with collagenase (0.45 ml 275 U) treatment. There were 23 cases of L4/5 lesions and 25 cases of L5/S1 lesions.Results Injection was done successfully in all patients. After 6 months, 48 patients were contacted for clinical follow-up and repeat CT examination were performed to verify the status of the herniated lumbar disc material. The clinical rate of excellence and good results were 93.7%. The protrusion reduced as by CT scan in 48 cases (100%). No allergic phenomena or neurologically adverse reactions were observed.Conclusion CT-guided percutaneous radiofrequency combined with collagenase is effective in treating lumbar disc hernia.

  5. Efficacy of percutaneous radiofrequency ablation of osteoid osteoma in children

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    Donkol, Ragab H. [Cairo University, Department of Radiology, Faculty of Medicine, Cairo (Egypt); Assir Central Hospital, Department of Radiology, P.O. Box 34, Abha (Saudi Arabia); Al-Nammi, Ahmed [Assir Central Hospital, Department of Radiology, P.O. Box 34, Abha (Saudi Arabia); Moghazi, Khaled [Alexandria University, Faculty of Medicine, Alexandria (Egypt)

    2008-02-15

    Percutaneous radiofrequency (RF) ablation of osteoid osteoma has high technical and clinical success rates. However, there are limited data on its use in the treatment of osteoid osteoma in children. To assess the safety and efficacy of CT-guided percutaneous RF ablation of osteoid osteoma in children and compare the outcomes with published data on its use in patients unselected for age. From January 2003 to July 2006, 23 children with osteoid osteoma were treated with CT-guided RF ablation using a straight rigid electrode. Their mean age was 11 years (range 3.5-16 years) and there were 15 boys and 8 girls. The procedures were carried out under general anaesthesia. Follow-up was performed to assess technical and clinical outcome. The mean follow-up period was 2.5 years (range 13-49 months). Technical success was achieved in 21 children (91.3%). Failure occurred in two children, in one due to failure to adequately localize the nidus within the dense sclerosis and in the other because of a short ablation time (2 min) because he developed hyperthermia. Clinical success was achieved in 18 patients within 2-5 days (primary clinical success rate 78.2%).These patients were allowed to fully weight-bear and function without limitation 1 week after the procedure. Pain recurrence was observed in two patients; one was treated successfully with a second ablation after 6 months (secondary clinical success rate 82.6%). Hyperthermia was observed in two patients during the procedure. Three other minor complications were observed: wound infection in one child and skin burn in two children. No major immediate or delayed complications were observed. Percutaneous CT-guided RF ablation is an effective and safe minimally invasive procedure for the treatment of osteoid osteoma in children. It has high technical and clinical success rates that are slightly lower than those of patients with a wider range of ages. (orig.)

  6. CT-guided percutaneous aspiration of Tarlov cyst as a useful diagnostic procedure prior to operative intervention.

    Science.gov (United States)

    Lee, J-Y; Impekoven, P; Stenzel, W; Löhr, M; Ernestus, R-I; Klug, N

    2004-07-01

    Tarlov or perineural cysts are lesions of the nerve root most often found in the sacral region. Several authors recommend surgical treatment of symptomatic Tarlov cysts. However, successful surgical treatment is dependent on appropriate patient selection. In this article, we report three cases of a sacral perineural cyst, causing sciatic pain, and emphasize the usefulness of CT-guided percutaneous aspiration as an important diagnostic and prognostic procedure prior to definitive operative treatment.

  7. CT-guided percutaneous thymus microwave radiation and local injection of dexamethasone for myasthenia gravis

    Institute of Scientific and Technical Information of China (English)

    WANG Pei-jun; YANG Ji-jin; L(U) Tao-zhen; TU Lai-hui; ZUO Chang-jing; ZHANG Ren-qin; CHEN Wei; SHAO Cheng-wei; WANG Min-jie; LIU Dong-ming

    2001-01-01

    Objective: To develop an effective therapy for myasthenia gravis (MG) with little traumatic injury and low morCT-guided percutaneous thymus paracentesis via the upper margin of the sternum incisure and with local dexamethasone injection. Results: The symptoms and signs were relieved within 3 d of treatment in all the 13 MG patients; three had immediate response to the treatment with improved myodynamia. A 3-year follow-up study showed that the symptoms and signs improved significantly in 10 patients and turned for the better in 3. The size of the thymus reduced vertically, transversely and anteroposteriorly by 24.2%, 31.7% and 34.1% respectively. Low-density areas were seen in the thymus due to water gasification and coagulation necrosis of the thymus tissue. Conclusion: The technique has definite therapeutic effect on MG with advantages of easy manipulation, quick response and low morbidity. It is suitable for MG patients with hyperplasia or thymoma, and those who are unwilling to receive thymectomy, or whose thymoma is not resectable, or those who have poor response to radiotherapy.

  8. Diagnostic Accuracy of PET/CT-Guided Percutaneous Biopsies for Malignant Peripheral Nerve Sheath Tumors in Neurofibromatosis Type 1 Patients.

    Directory of Open Access Journals (Sweden)

    Mehdi Brahmi

    Full Text Available Malignant peripheral nerve sheath tumors (MPNST are one of the most frequent causes of death in patients with neurofibromatosis type 1 (NF1. Early detection is crucial because complete surgical resection is the only curative treatment. It has been previously reported that an 18F-fluorodeoxyglucose (FDG positron emission tomography/computed tomography (PET/CT image with a T/L (Tumor/Liver SUV max ratio > 1.5 provides a high negative predictive value; however, it is not specific enough to make a NF1-related MPNST diagnosis. A formal proof of malignant transformation from a histological analysis is necessary before surgical excision because the procedure can cause mutilation. The objective of the present work was to investigate the effectiveness of and complications associated with PET/CT-guided percutaneous biopsies for an NF1-related MPNST diagnosis.PET/CT-guided percutaneous biopsy procedures performed on 26 NF1 patients with a clinical suspicion of MPNST and a suspect lesion from a PET/CT scan (T/L SUV max ratio > 1.5 were retrospectively evaluated. The localization of the suspected malignant site was determined using PET/CT. A stereotactic (ultrasonic and CT control core biopsy technique was used with a local anesthesia.The first PET/CT-guided percutaneous biopsies enabled a pathological diagnosis for all of the patients (no "inconclusive " results were obtained, and no secondary procedures were needed. Among the 26 patients, the histopathological results from the biopsy were malignant in 17 cases and benign (BPNST with atypical cells in nine cases. No complications from the diagnostic procedure were observed. A surgical resection was performed in 18 patients (seven benign and 11 malignant biopsies, removing the fine needle biopsy scar. In addition, six locally advanced/metastatic MPNST were treated with chemo/radiotherapy, and two BPNST had no progression after a follow-up of 14 and 39 months, respectively. The PET/CT-guided percutaneous

  9. CT-guided percutaneous microwave ablation of pulmonary malignancies: Results in 69 cases

    Directory of Open Access Journals (Sweden)

    Lu Qiang

    2012-05-01

    Full Text Available Abstract Background Microwave ablation (MWA has attracted a worldwide attention gradually in treating inoperable pulmonary malignancies. However, in the lung tissues treated with MWA recurrence of tumor may still occur and few data in large patient groups till now were reported about the safety or effectiveness of microwave ablation in treating primary lung cancer and metastatic pulmonary malignancies. The purpose of this study is to evaluate the clinical curative effect (local control, survival data MWA and its safety as well. Methods From 1 January 2005 to 1 January 2008, retrospective analyses, 69 patients underwent computed tomography (CT-guided percutaneous MWA of pulmonary malignancies. All patients were deemed medically inoperable. The correlation of tumor sizes and local progression after ablation was analyzed and the survival rates within 3 years post surgery were compared between non-small-cell lung cancer and pulmonary metastases groups also. Results Pneumothorax was the most frequent complication and occurred in 24.64% patients after ablation. Neither needle track implantation was found nor did patient death occur in these patients within 30 days. The 1-, 2-, and 3-year overall survival rates were 66.7%, 44.9% and 24.6%, respectively. The overall survival rates for NSCLC patients in 1 year, 2 years, and 3 years were 75.0%, 54.2%, and 29.2%, respectively. The overall survival rates for pulmonary metastatic tumor patients in 1 year, 2 years, and 3 years were 47.6%, 23.8%, and 14.3%, respectively. The recurrence-free survival rates for NSCLC patients in 1 year, 2 years, and 3 years were 72.9%, 50.0%, and 27.1%, respectively. The mortality rates for pulmonary metastatic tumor patients in 1 year, 2 years, and 3 years were 47.6%, 19.0%, and 14.3%, respectively. Conclusions Percutaneous microwave coagulation therapy was one safe and effective method and could be beneficial for the improvement of inoperable

  10. CT-Guided Percutaneous Transthoracic Localization of Pulmonary Nodules Prior to Video-Assisted Thoracoscopic Surgery Using Barium Suspension

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    Lee, Nyoung Keun; Park, Chang Min; Kang, Chang Hyun; Jeon, Yoon Kyung; Choo, Ji Yung; Lee, Hyun Ju; Goo, Jin Mo [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2012-11-15

    To describe our initial experience with CT-guided percutaneous barium marking for the localization of small pulmonary nodules prior to video-assisted thoracoscopic surgery (VATS). From October 2010 to April 2011, 10 consecutive patients (4 men and 6 women; mean age, 60 years) underwent CT-guided percutaneous barium marking for the localization of 10 small pulmonary nodules (mean size, 7.6 mm; range, 3-14 mm): 6 pure ground-glass nodules, 3 part-solid nodules, and 1 solid nodule. A 140% barium sulfate suspension (mean amount, 0.2 mL; range, 0.15-0.25 mL) was injected around the nodules with a 21-gauge needle. The technical details, surgical findings and pathologic features associated with barium localizations were evaluated. All nodules were marked within 3 mm (mean distance, 1.1 mm; range, 0-3 mm) from the barium ball (mean diameter, 9.6 mm; range, 8-16 mm) formed by the injected barium suspension. Pneumothorax occurred in two cases, for which one needed aspiration. However, there were no other complications. All barium balls were palpable during VATS and visible on intraoperative fluoroscopy, and were completely resected. Both the whitish barium balls and target nodules were identifiable in the frozen specimens. Pathology revealed one invasive adenocarcinoma, five adenocarcinoma-in-situ, two atypical adenomatous hyperplasias, and two benign lesions. In all cases, there were acute inflammations around the barium balls which did not hamper the histological diagnosis of the nodules. CT-guided percutaneous barium marking can be an effective, convenient and safe pre-operative localization procedure prior to VATS, enabling accurate resection and diagnosis of small or faint pulmonary nodules.

  11. Percutaneous CT-Guided Cryoablation as an Alternative Treatment for an Extensive Pelvic Bone Giant Cell Tumor

    Energy Technology Data Exchange (ETDEWEB)

    Panizza, Pedro Sergio Brito; Albuquerque Cavalcanti, Conrado Furtado de [Sírio Libânes Hospital, Radiology and Imaged Guided Intervention Service (Brazil); Yamaguchi, Nise Hitomi [Instituto Avanços em Medicina (Brazil); Leite, Claudia Costa; Cerri, Giovanni Guido; Menezes, Marcos Roberto de, E-mail: marcos.menezes@hc.fm.usp.br [Sírio Libânes Hospital, Radiology and Imaged Guided Intervention Service (Brazil)

    2016-02-15

    A giant cell tumor (GCT) is an intermediate grade, locally aggressive neoplasia. Despite advances in surgical and clinical treatments, cases located on the spine and pelvic bones remain a significant challenge. Failure of clinical treatment with denosumab and patient refusal of surgical procedures (hemipelvectomy) led to the use of cryoablation. We report the use of percutaneous CT-guided cryoablation as an alternative treatment, shown to be a minimally invasive, safe, and effective option for a GCT with extensive involvement of the pelvic bones and allowed structural and functional preservation of the involved bones.

  12. Single-Session CT-Guided Percutaneous Microwave Ablation of Bilateral Adrenal Gland Hyperplasia Due to Ectopic ACTH Syndrome.

    Science.gov (United States)

    Sarma, Asha; Shyn, Paul B; Vivian, Mark A; Ng, Ju-Mei; Tuncali, Kemal; Lorch, Jorchen H; Zaheer, Sarah N; Gordon, Michael S; Silverman, Stuart G

    2015-10-01

    Bilateral adrenalectomy is currently the only available treatment for adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (ectopic ACTH syndrome) that is refractory to pharmacologic therapy. We describe two patients with refractory ectopic ACTH syndrome who were treated with CT-guided percutaneous microwave ablation of both hyperplastic adrenal glands in a single session: O ne was not a surgical candidate, and the other had undergone unsuccessful surgery. Following the procedure, both patients achieved substantial decreases in serum cortisol, symptomatic improvement, and decreased anti-hypertensive medication requirements.

  13. Single-Session CT-Guided Percutaneous Microwave Ablation of Bilateral Adrenal Gland Hyperplasia Due to Ectopic ACTH Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Sarma, Asha, E-mail: ashasarma@gmail.com; Shyn, Paul B., E-mail: pshyn@partners.org [Brigham and Women’s Hospital, Department of Radiology (United States); Vivian, Mark A. [University of Manitoba, Department of Radiology (Canada); Ng, Ju-Mei [Brigham and Women’s Hospital, Department of Anesthesiology (United States); Tuncali, Kemal [Brigham and Women’s Hospital, Department of Radiology (United States); Lorch, Jorchen H. [Dana Farber Cancer Institute, Department of Medicine (United States); Zaheer, Sarah N.; Gordon, Michael S. [Brigham and Women’s Hospital, Department of Endocrinology (United States); Silverman, Stuart G. [Brigham and Women’s Hospital, Department of Radiology (United States)

    2015-10-15

    Bilateral adrenalectomy is currently the only available treatment for adrenocorticotropic hormone (ACTH)-dependent Cushing’s syndrome (ectopic ACTH syndrome) that is refractory to pharmacologic therapy. We describe two patients with refractory ectopic ACTH syndrome who were treated with CT-guided percutaneous microwave ablation of both hyperplastic adrenal glands in a single session: One was not a surgical candidate, and the other had undergone unsuccessful surgery. Following the procedure, both patients achieved substantial decreases in serum cortisol, symptomatic improvement, and decreased anti-hypertensive medication requirements.

  14. Predicting factors for conversion from fluoroscopy guided Percutaneous transthoracic needle biopsy to cone-beam CT guided Percutaneous transthoracic needle biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kang Ji; Han, Young Min; Jin, Gong Yong; Song, Ji Soo [Chonbuk National Univ., Jeonju (Korea, Republic of)

    2015-10-15

    To evaluate the predicting factors for conversion from fluoroscopy guided percutaneous transthoracic needle biopsy (PTNB) to cone-beam CT guided PTNB. From January 2011 to December 2012, we retrospectively identified 38 patients who underwent cone-beam CT guided PTNB with solid pulmonary lesions, and 76 patients who underwent fluoroscopy guided PTNB were matched to the patients who underwent cone-beam CT guided PTNB for age, sex, and lesion location. We evaluated predicting factors such as, long-axis diameter, short-axis diameter, anterior-posterior diameter, and CT attenuation value of the solid pulmonary lesion affecting conversion from fluoroscopy guided PTNB to cone-beam CT guided PTNB. Pearson χ{sup 2} test, Fisher exact test, and independent t test were used in statistical analyses; in addition, we also used receiver operating characteristics curve to find the proper cut-off values affecting the conversion to cone-beam CT guided PTNB. Short-axis, long-axis, anterior-posterior diameter and CT attenuation value of the solid pulmonary lesion in patients who underwent fluoroscopy guided PTNB were 2.70 ± 1.57 cm, 3.40 ± 1.92 cm, 3.06 ± 1.81 cm, and 35.67 ± 15.70 Hounsfield unit (HU), respectively. Short-axis, long-axis, anterior-posterior diameter and CT attenuation value of the solid pulmonary lesion in patients who underwent cone-beam CT guided PTNB were 1.60 ± 1.30 cm, 2.20 ± 1.45 cm, 1.91 ± 1.99 cm, and 18.32 ± 23.11 HU, respectively. Short-axis, long-axis, anterior-posterior diameter, and CT attenuation value showed a significantly different mean value between the 2 groups (p = 0.001, p < 0.001, p = 0.003, p < 0.001, respectively). Odd ratios of CT attenuation value and short-axis diameter of the solid pulmonary lesion were 0.952 and 0.618, respectively. Proper cut-off values affecting the conversion to cone-beam CT guided PTNB were 1.65 cm (sensitivity 68.4%, specificity 71.1%) in short-axis diameter and 29.50 HU (sensitivity 65.8%, specificity 65

  15. Percutaneous radiofrequency thermal lumbar sympathectomy and its clinical use

    NARCIS (Netherlands)

    J. Pernak (Jamina)

    1988-01-01

    textabstractPercutaneous radiofrequency thermolesion techniques are commonly used in the treatment of chronic pain in different pain syndromes. There are many reports describing techniques of percutaneous radiofrequency thermolesion for denervation of central & spinal nerves (Mullan 1963), 1965,

  16. Transcatheter arterial chemoembolization combined with CT-guided percutaneous thermal ablation versus hepatectomy in the treatment of hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Sheng Li; Liang Zhang; Zhi-Mei Huang; Pei-Hong Wu

    2015-01-01

    Introduction:Transcatheter arterial chemoembolization (TACE) plus thermal ablation has been widely used recently in the treatment of hepatocellular carcinoma (HCC). In this study, we aimed to compare results of the combination of TACE and percutaneous thermal ablation with those of hepatectomy in patients with HCC. Methods:The clinical data of 137 HCC patients who sequentially received TACE and computed tomography (CT)-guided percutaneous thermal ablation as an initial curative treatment (combination group) and 148 matched HCC patients who received hepatectomy (surgery group) between 2004 and 2011 were collected and analyzed. After TACE, multiphase contrast-enhanced CT was performed to identify the total number of tumors as well as lipiodol deposition in the liver. Survival was calculated by using the Kaplan-Meier method and compared by using the log-rank test. The prognostic factors were assessed with multivariate Cox proportional hazards regression analysis. Results:Of all 285 patients, 225 (79.0%) had cancerous lesions≤5 cm in diameter. In preoperative contrast-enhanced CT or magnetic resonance imaging, the number of tumors was 1–4 for each patient. The 1-, 3-, and 5-year overal survival rates were 95, 74%, and 67%in the combination group and 88, 66, and 47%in the surgery group, respectively (P=0.004);the corresponding recurrence-free survival rates for the two groups were 92, 69, and 61%and 75, 58, and 44%, respectively (P=0.001). In the multivariate analysis, treatment al ocation was an independent prognostic factor for survival. Only 60 patients in the combination group had sufficient imaging data, and 135 new lesions with lipiodol deposition were diagnosed as malignancies in 22 of 60 patients, whereas 20 new lesions were found in 11 of 148 patients in the surgery group. Conclusion:The combination of TACE and CT-guided percutaneous thermal ablation for HCC improves survival of HCC patients compared with hepatectomy.

  17. CT-guided percutaneous drainage of intra-abdominal abscesses: APACHE III score stratification of 1-year results

    Energy Technology Data Exchange (ETDEWEB)

    Betsch, Angelika; Belka, Claus [Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany); Wiskirchen, Jakub; Truebenbach, Jochen; Claussen, Claus D.; Duda, Stephan H. [Department of Diagnostic Radiology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany); Manncke, Klaus H. [Department of General Surgery, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany)

    2002-12-01

    Our objective was to evaluate the clinical success rates of percutaneously drained intra-abdominal abscesses using a risk stratification score for severely ill patients (APACHE III; Acute Physiology, Age, Chronic Health Evaluation). In 75 patients CT-guided percutaneous abscess drainage was performed to treat intra-abdominal abscesses. The clinical success rate based on a 1-year follow-up was correlated with abscess etiology, size, and structure, as well as with the initial APACHE III score. Clinical success, i.e., the complete removal of the abscess without surgical treatment, was observed in 62 of 75 patients (83%). Abscess size (<200 cm{sup 3}) and abscesses with a simple structure correlated with higher clinical success rates. Patients presenting with APACHE III scores below 30 were treated by percutaneous abscess drainages (PAD) alone significantly more often than patients presenting with higher APACHE scores. The percutaneous drainage of intra-abdominal abscesses shows good long-term results as long as abscesses are singular, small (<200 cm{sup 3}), and located in well accessible regions in combination with low APACHE scores (<30). (orig.)

  18. CT-guided Bipolar and Multipolar Radiofrequency Ablation (RF Ablation) of Renal Cell Carcinoma: Specific Technical Aspects and Clinical Results

    Energy Technology Data Exchange (ETDEWEB)

    Sommer, C. M., E-mail: christof.sommer@med.uni-heidelberg.de [University Hospital Heidelberg, INF 110, Department of Diagnostic and Interventional Radiology (Germany); Lemm, G.; Hohenstein, E. [Minimally Invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn GmbH, Clinic for Radiology (Germany); Bellemann, N.; Stampfl, U. [University Hospital Heidelberg, INF 110, Department of Diagnostic and Interventional Radiology (Germany); Goezen, A. S.; Rassweiler, J. [Clinic for Urology, SLK Kliniken Heilbronn GmbH (Germany); Kauczor, H. U.; Radeleff, B. A. [University Hospital Heidelberg, INF 110, Department of Diagnostic and Interventional Radiology (Germany); Pereira, P. L. [Minimally Invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn GmbH, Clinic for Radiology (Germany)

    2013-06-15

    Purpose. This study was designed to evaluate the clinical efficacy of CT-guided bipolar and multipolar radiofrequency ablation (RF ablation) of renal cell carcinoma (RCC) and to analyze specific technical aspects between both technologies. Methods. We included 22 consecutive patients (3 women; age 74.2 {+-} 8.6 years) after 28 CT-guided bipolar or multipolar RF ablations of 28 RCCs (diameter 2.5 {+-} 0.8 cm). Procedures were performed with a commercially available RF system (Celon AG Olympus, Berlin, Germany). Technical aspects of RF ablation procedures (ablation mode [bipolar or multipolar], number of applicators and ablation cycles, overall ablation time and deployed energy, and technical success rate) were analyzed. Clinical results (local recurrence-free survival and local tumor control rate, renal function [glomerular filtration rate (GFR)]) and complication rates were evaluated. Results. Bipolar RF ablation was performed in 12 procedures and multipolar RF ablation in 16 procedures (2 applicators in 14 procedures and 3 applicators in 2 procedures). One ablation cycle was performed in 15 procedures and two ablation cycles in 13 procedures. Overall ablation time and deployed energy were 35.0 {+-} 13.6 min and 43.7 {+-} 17.9 kJ. Technical success rate was 100 %. Major and minor complication rates were 4 and 14 %. At an imaging follow-up of 15.2 {+-} 8.8 months, local recurrence-free survival was 14.4 {+-} 8.8 months and local tumor control rate was 93 %. GFR did not deteriorate after RF ablation (50.8 {+-} 16.6 ml/min/1.73 m{sup 2} before RF ablation vs. 47.2 {+-} 11.9 ml/min/1.73 m{sup 2} after RF ablation; not significant). Conclusions. CT-guided bipolar and multipolar RF ablation of RCC has a high rate of clinical success and low complication rates. At short-term follow-up, clinical efficacy is high without deterioration of the renal function.

  19. Percutaneous treatment of bone tumors by radiofrequency thermal ablation

    Energy Technology Data Exchange (ETDEWEB)

    Ruiz Santiago, Fernando, E-mail: ferusan@ono.com [Department of Radiology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18013 Granada (Spain); Mar Castellano Garcia, Maria del; Guzman Alvarez, Luis [Department of Radiology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18013 Granada (Spain); Martinez Montes, Jose Luis [Department of Traumatology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18013 Granada (Spain); Ruiz Garcia, Manuel; Tristan Fernandez, Juan MIguel [Department of Radiology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18013 Granada (Spain)

    2011-01-15

    We present our experience of the treatment of bone tumors with radiofrequency thermal ablation (RFTA). Over the past 4 years, we have treated 26 cases (22 benign and 4 malignant) using CT-guided RFTA. RFTA was the sole treatment in 19 cases and was combined with percutaneous cementation during the same session in the remaining seven cases. Our approach to the tumors was simplified, using a single point of entrance for both RFTA and percutaneous osteoplasty. In the benign cases, clinical success was defined as resolution of pain within 1 month of the procedure and no recurrence during the follow-up period. It was achieved in 19 out of the 21 patients in which curative treatment was attempted. The two non-resolved cases were a patient with osteoid osteoma who developed a symptomatic bone infarct after a symptom-free period of 2 months and another with femoral diaphysis osteoblastoma who suffered a pathological fracture after 8 months without symptoms. The procedure was considered clinically successful in the five cases (4 malign and 1 benign) in which palliative treatment was attempted, because there was a mean ({+-}SD) reduction in visual analogue scale (VAS) pain score from 9.0 {+-} 0.4 before the procedure to <4 during the follow-up period.

  20. CT-guided percutaneous gastrostomy: success rate, early and late complications; CT-gesteuerte perkutane Gastrostomie: Technischer Erfolg, Frueh- und Spaetkomplikationen

    Energy Technology Data Exchange (ETDEWEB)

    Gottschalk, A.; Voelk, M. [Radiologie, Bundeswehrkrankenhaus Ulm (Germany); Strotzer, M. [Radiologie, Klinikum Hohe Warte (Germany); Feuerbach, S.; Rogler, G. [Radiologie, Klinikum der Universitaet Regensburg (Germany); Seitz, J. [Radiologie, MVZ Dr. Neumaier und Kollegen (Germany)

    2007-04-15

    Purpose: Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are the standard methods of ensuring long-term enteral food intake in patients with dysphagia caused by neoplasia or neurological disorders. High-grade obstructions of the upper digestive tract or inadequate transillumination can prevent PEG. CT-guided percutaneous gastrostomy (PG) represents a special technique for enabling gastrostomy in patients for whom the endoscopic method is impossible. The aim of this study was to evaluate the results and complications of CT-guided percutaneous gastrostomy. Materials and Methods: CT-guided PG was performed in 83 patients, mostly with malignancy of the upper respiratory or digestive tract. Medical records for these patients were reviewed, and the results and complications of the CT-guided PG were analyzed retrospectively. Complications were grouped into four categories: Major and minor complications as well as early and late complications. Results: In 95.2 % of all cases (79/83), CT-guided PG was successful in the first attempt. Within the first 3 days, 5 major complications including 4 tube dislocations and one case of peritonitis were found in 4/79 patients (5.1 %). One of these patients experienced two early major complications. Early minor complications, mainly local skin irritations and temporary stomachache, were observed in 31 patients (39.2 %). Three days after CT-guided PG, 4 cases of major complications were documented, yielding a total rate of major complications was 8.7 % (7/79). Hemorrhage requiring blood transfusion or perforation after gastrostomy was not observed. 29.1 % of the patients (23/79) experienced late minor complications. (orig.)

  1. Percutaneous radiofrequency treatment of osteoid osteoma using cool-tip electrodes

    Energy Technology Data Exchange (ETDEWEB)

    Martel, Jose [Departamento de Diagnostico por Imagen, Fundacion Hospital Alcorcon, Avda. de Budapest s/n, 28922 Alcorcon, Madrid (Spain)]. E-mail: jmartel@fhalcorcon.es; Bueno, Angel [Departamento de Diagnostico por Imagen, Fundacion Hospital Alcorcon, Avda. de Budapest s/n, 28922 Alcorcon, Madrid (Spain); Ortiz, Eduardo [Departamento de Cirugia ortopedica, Fundacion Hospital Alcorcon, Madrid (Spain)

    2005-12-15

    Objectives: To report our experience with percutaneous cool-tip radiofrequency ablation of osteoid osteomas and to evaluate clinical outcome. Methods and material: Forty-one patients with clinically and radiologically suspected osteoid osteoma were seen over a 48-month period (27 males and 14 females with a mean age of 18.7 years; range 5-43 years). Thirty-eight patients were treated by computed tomography (CT)-guided percutaneous radiofrequency ablation. The procedure was performed under regional or general anaesthesia. After location of the nidus, a 14G-bone biopsy needle is introduced into the nidus. Sampling is performed with a 17G-bone biopsy needle using a coaxial technique. The radiofrequency needle with a 10 mm active tip (cool-tip) is inserted through the biopsy needle and is connected to the radiofrequency generator for 6-8 min. Results: Primary success was obtained in 37 patients (97%) with a 100% secondary success rate. All patients are currently pain-free. No major complications occurred. Patients could resume unrestricted normal activity within 24 h. Conclusions: Percutaneous radiofrequency ablation of osteoid osteomas is an efficient and safe method that can be considered the procedure of choice for most cases.

  2. CT-guided thin needles percutaneous cryoablation (PCA) in patients with primary and secondary lung tumors: A preliminary experience

    Energy Technology Data Exchange (ETDEWEB)

    Pusceddu, Claudio, E-mail: clapusceddu@gmail.com [Division of Interventional Radiology, Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncologic Diseases, Cagliari, Zip code 09100 (Italy); Sotgia, Barbara, E-mail: barbara.sotgia@gmail.com [Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncological Diseases, Cagliari, Zip code 09100 (Italy); Fele, Rosa Maria, E-mail: rosellafele@tiscali.it [Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncological Diseases, Cagliari, Zip code 09100 (Italy); Melis, Luca, E-mail: doclucamelis@tiscali.it [Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncological Diseases, Cagliari, Zip code 09100 (Italy)

    2013-05-15

    Purpose: To report the data of our initial experience with CT-guided thin cryoprobes for percutaneous cryoablation (PCA) in patients with primary and secondary pulmonary tumors. Material and methods: CT-guided thin needles PCA was performed on 34 lung masses (11 NSCLC = 32%; 23 secondary lung malignancies = 68%) in 32 consecutive patients (24 men and 8 women; mean age 67 ± 10 years) not suitable for surgical resection. Lung masses were treated using two types of cryoprobes: IceRod and IceSeed able to obtain different size of iceball. The number of probes used ranged from 1 to 5 depending on the size of the tumor. After insertion of the cryoprobes into the lesion, the PCA were performed with two 2 (91%) or 3 (9%) cycles each of 12 min of freezing followed by a 4 min active thawing phase and a 4 min passive thawing phase for each one for all treatments. Results: All cryoablation sessions were successfully completed. All primary and metastatic lung tumors were ablated. No procedure-related deaths occurred. Morbidity consisted of 21% (7 of 34) pneumothorax and 3% (1 of 34) cases asymptomatic small pulmonary hemorrhage, respectively, all of CTCAE grade 1 (Common Terminology Criteria for Adverse Events). Low density of entire lesion, central necrosis and solid mass appearance were identify in 21 (62%), 7 (21%) and 6 (17%) of cryoablated tumors, respectively. No lymphadenopathy developed in the region of treated lesions. Technical success (complete lack of enhancement) was achieved in 82%, 97% and 91% of treated lesions at 1-, 3- and 6-months CT follow-up scan, respectively (p < .000). Comparing the tumor longest diameter between the baseline and at 6 month CT images, technical success was revealed in 92% cases (p < .000). Conclusion: Our preliminary experience suggests that PCA is a feasible treatment option. Well-designed clinical trials with a larger patient population are necessary to further investigate the long-term results and prognostic factors.

  3. Percutaneous CT-Guided Treatment of Osteochondritis Dissecans of the Sacroiliac Joint

    Energy Technology Data Exchange (ETDEWEB)

    Becce, Fabio, E-mail: fabio.becce@chuv.ch [University of Lausanne, Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (Switzerland); Mouhsine, Elyazid [Clinique Hirslanden Bois-Cerf, Department of Orthopaedic Surgery (Switzerland); Mosimann, Pascal John; Anaye, Anass [University of Lausanne, Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (Switzerland); Letovanec, Igor [University Institute of Pathology, Centre Hospitalier Universitaire Vaudois (Switzerland); Theumann, Nicolas [University of Lausanne, Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (Switzerland)

    2012-08-15

    Osteochondritis dissecans (OCD) is a joint disorder that affects the articular cartilage and subchondral bone, most commonly at the knee. OCD of the sacroiliac joint is extremely rare. Management of OCD remains controversial, and surgery is often needed, especially when conservative treatment fails. We present a rare case of OCD involving the left sacroiliac joint successfully treated by percutaneous computed tomography-guided retrograde drilling and debridement.

  4. CT guided percutaneous pulmonary sextant biopsy clinical should%CT引导下经皮肺穿刺活检术的临床应用

    Institute of Scientific and Technical Information of China (English)

    李玉

    2010-01-01

    Objective To explore the lung CT guided percutaneous biopsy strategies in clinical application value. Methods Dltra2Cut needle biopsy tissue type 18G cut in SEMENS64 row spiral CT guided puncture 68 cases of lung disease around. Results 68 cases of lung biopsy, percutaneous by pathological diagnosis 61 cases diagnosed as 91% , postoperative pneumothorax in 5 cases ,3 cases of pulmonary hemorrhage, hemoptysis in both cases. Conclusion CT guided percutaneous pulmonary sextant biopsy safety, economy, high accuracy,slight trauma,has value of clinical applications.%目的 探讨CT引导下经皮肺穿刺活检术在临床应用中的价值.方法 采用Dltra2Cut型18G软组织切割活检针在SEMENS64排螺旋CT引导下穿刺68例肺周围病变患者.结果 68例经皮肺穿刺活检,经病理诊断明确61例,诊断率为91%,术后气胸5例,肺出血3例,咳血2例均愈.结论 CT引导下经皮肺穿刺活检术安全、经济、准确率高、创伤小,具有临床应用价值.

  5. Symptomatic Lumbar Facet Synovial Cysts: Clinical Outcomes Following Percutaneous CT-Guided Cyst Rupture with Intra-articular Steroid Injection.

    Science.gov (United States)

    Haider, Steffen J; Na, Nu R; Eskey, Clifford J; Fried, Jessica G; Ring, Natalie Y; Bao, Mike H; Pastel, David A

    2017-08-01

    To evaluate clinical outcomes following percutaneous rupture of symptomatic lumbar facet synovial cysts (LFSCs) with intra-articular steroid injection. In this retrospective review, 44 consecutive patients with symptomatic LFSCs received primary treatment with CT-guided synovial cyst rupture with intra-articular steroid injection. Outcomes questionnaires were obtained before and 1, 4, 26, and 52 weeks after LFSC rupture. Assessment included pain medication use and numeric rating scale (NRS), Oswestry Disability Index (ODI), and 12-item short form health survey (SF-12) physical and mental composite scores (PCS and MCS). Clinical endpoint was 52-week survey response or surgery. LFSC rupture was technically successful in 84% (37/44) of cases. Clinical endpoint was reached in 68% (30/44) of patients with 82% overall 1-year follow-up. Lumbar spine surgery was performed in 25% (11/44) of patients within 1 year after procedure. Mean NRS, ODI, and SF-12 PCS demonstrated significant improvement at all follow-up time points (P < .001). At 52-week follow-up, NRS decreased from 8.1 to 3.7 (P < .001), ODI improved from 35 to 24 (P = .006), and SF-12 PCS improved from 31 to 42 (P < .001). Daily pain medication decreased from 71% (31/44) of patients before procedure to 29% (9/26) at 52-week follow-up (P = .012). History of prior lumbar intervention was associated with poorer LFSC rupture success (P = .025) and ODI (P = .047). NRS, ODI, and SF-12 PCS indices improved and pain medication use decreased significantly at all time points over 1-year follow-up after percutaneous rupture of symptomatic LFSCs with intra-articular steroid injection. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

    Kastler, Adrian [University Hospital CHU Gabriel Montpied, Radiology Department, Clermont-Ferrand (France); Franche Comte University, I4S Laboratory-EA 4268-IFR 133, Besancon (France); CHU Clermont-Ferrand, Hopital Gabriel Montpied, Clermont-Ferrand (France); Aubry, Sebastien; Kastler, Bruno [University Hospital CHU Jean Minjoz, Radiology and Interventional Pain Unit, Besancon (France); Franche Comte University, I4S Laboratory-EA 4268-IFR 133, Besancon (France); Sailley, Nicolas; Michalakis, Demosthene [University Hospital CHU Jean Minjoz, Radiology and Interventional Pain Unit, Besancon (France); Siliman, Gaye [University Hospital CHU St Jacques, Clinical Investigation Center, Besancon (France); Gory, Guillaume [Franche Comte University, I4S Laboratory-EA 4268-IFR 133, Besancon (France); Lajoie, Jean-Louis [University Hospital CHU Jean Minjoz, Pain evaluation and Management Unit, Besancon (France)

    2013-05-15

    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. 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. 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. 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. (orig.)

  7. Percutaneous CT-guided needle biopsies of musculoskeletal tumors: a 5-year analysis of non-diagnostic biopsies

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Connie Y.; Huang, Ambrose J.; Bredella, Miriam A.; Torriani, Martin; Rosenthal, Daniel I. [Massachusetts General Hospital, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); Halpern, Elkan F. [Massachusetts General Hospital, Institute for Technology Assessment, Department of Radiology, Boston, MA (United States); Springfield, Dempsey S. [Massachusetts General Hospital, Department of Orthopedics, Boston, MA (United States)

    2015-12-15

    To study non-diagnostic CT-guided musculoskeletal biopsies and take steps to minimize them. Specifically we asked: (1) What malignant diagnoses have a higher non-diagnostic rate? (2) What factors of a non-diagnostic biopsy may warrant more aggressive pursuit? (3) Do intra-procedural frozen pathology (FP) or point-of-care (POC) cytology reduce the non-diagnostic biopsy rate ?This study was IRB-approved and HIPAA-compliant. We retrospectively reviewed 963 consecutive CT-guided musculoskeletal biopsies. We categorized pathology results as malignant, benign, or non-diagnostic and recorded use of FP or POC cytology. Initial biopsy indication, final diagnosis, method of obtaining the final diagnosis of non-diagnostic biopsies, age of the patient, and years of biopsy attending experience were recorded. Groups were compared using Pearson's χ{sup 2} test or Fisher's exact test. In all, 140 of 963 (15 %) biopsies were non-diagnostic. Lymphoma resulted in more non-diagnostic biopsies (P < 0.0001). While 67% of non-diagnostic biopsies yielded benign diagnoses, 33% yielded malignant diagnoses. Patients whose percutaneous biopsy was indicated due to the clinical context without malignancy history almost always generated benign results (96 %). Whereas 56% of biopsies whose indication was an imaging finding of a treatable lesion were malignant, 20% of biopsies whose indication was a history of malignancy were malignant. There was no statistically significant difference in the nondiagnostic biopsy rates of pediatric versus adult patients (P = 0.8) and of biopsy attendings with fewer versus more years of experience (P = 0.5). The non-diagnostic rates of biopsies with FP (8 %), POC cytology (25 %), or neither (24 %) were significantly different (P < 0.0001). Lymphoma is the malignant diagnosis most likely to result in a non-diagnostic biopsy. If the clinical and radiologic suspicion for malignancy is high, repeat biopsy is warranted. If the clinical context suggests a

  8. CT-guided radiofrequency (RF) ablation of osteoid osteoma. Clinical long-term results; CT-gesteuerte Radiofrequenz(RF)-Ablation von Osteoidosteomen. Klinische Langzeitergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, Diethard; Clasen, S.; Schaefer, J.F.; Rempp, H.; Koenig, C.W.; Claussen, C.D. [Universitaetsklinikum Tuebingen (Germany). Abt. fuer Diagnostische und Interventionelle Radiologie; Duda, S.; Truebenbach, J. [Juedisches Krankenhaus, Berlin (Germany). Radiologen Praxis; Erdtmann, B. [Radiologie Zentrum Stuttgart, Bad Cannstatt (Germany). Praxis; Pereira, P.L. [SLK-Kliniken, Heilbronn (Germany). Klinik fuer Radiologie, Minimal-Invasive Therapien und Nuklearmedizin

    2011-04-15

    Purpose: To evaluate CT-guided radiofrequency (RF) ablation of osteoid osteoma using internally cooled monopolar RF electrodes for technical success, complications and clinical long-term success. Materials and Methods: Between April 1999 and July 2009, 23 patients were treated under general anesthesia with CT-guided RF ablation using an internally cooled monopolar single RF electrode (Cool-tip, Valleylab, TycoHealthcare, Boulder, USA; active tip: 10 mm). For the removal of the nidus, we used either a manual or an automated drill. The technical success was evaluated by a CT scan (MSCT, Siemens Medical Solutions, Forchheim). The clinical long-term success was investigated by questioning patients prior to discharge, and after 6, 12 and 18 months. After 18 months, patients were interviewed on an annual basis. Results: The technical success rate was 100 %. The nidus was located in n = 19 cases at the lower extremity and in n = 4 cases at the upper extremity. Minor complications were observed for n = 2 patients. The mean hospitalization time was 1.5 d (1-2 d). The mean follow-up was 75.9 months (18-120 months) for n = 23 patients. No local recurrence was observed. One patient had intermediate pain one week after RF ablation without recurrent symptoms. Conclusion: CT-guided RF ablation using an internally cooled monopolar single RF electrode is an effective and safe minimally invasive method for the treatment of osteoid osteoma with excellent clinical long-term success. (orig.)

  9. Clinical application of CT and CT-guided percutaneous transthoracic needle biopsy in patients with indeterminate pulmonary nodules

    Energy Technology Data Exchange (ETDEWEB)

    Cardoso, Luciana Vargas; Souza Júnior, Arthur Soares, E-mail: fabianonatividade@terra.com.br [Rio Preto-Ultra-X Radiological Diagnosis Institute, São José do Rio Preto, SP (Brazil)

    2014-07-15

    Objective: To investigate the clinical application of CT and CT-guided percutaneous transthoracic needle biopsy (CT-PTNB) in patients with indeterminate pulmonary nodules (IPNs). Methods: We retrospectively studied 113 patients with PNs undergoing CT and CT-PTNB. Variables such as gender, age at diagnosis, smoking status, CT findings, and CT-PTNB techniques were analyzed. Data analysis was performed with the Student's t-test for independent samples the chi-square test, and normal approximation test for comparison of two proportions. Results: Of the 113 patients studied, 68 (60.2%) were male and 78 (69%) were smokers. The diameter of malignant lesions ranged from 2.6 cm to 10.0 cm. Most of the IPNs (85%) were located in the peripheral region. The biopsied IPNs were found to be malignant in 88 patients (77.8%) and benign in 25 (22.2%). Adenocarcinoma was the most common malignant tumor, affecting older patients. The IPN diameter was significantly greater in patients with malignant PNs than in those with benign IPNs (p < 0.001). Having regular contour correlated significantly with an IPN being benign (p = 0.022), whereas spiculated IPNs and bosselated IPNs were more often malignant (in 50.7% and 28.7%, respectively). Homogeneous attenuation and necrosis were more common in patients with malignant lesions (51.9% and 26.9%, respectively). Conclusions: In our sample, CT and CT-PTNB were useful in distinguishing between malignant and benign IPNs. Advanced age and smoking were significantly associated with malignancy. Certain CT findings related to IPNs (larger diameter, spiculated borders, homogeneous attenuation, and necrosis) were associated with malignancy. (author)

  10. CT-guided percutaneous drainage in the treatment of abdominal abscess%CT引导下经皮穿刺引流术治疗腹部脓肿

    Institute of Scientific and Technical Information of China (English)

    钟涛; 王勇; 于红光

    2013-01-01

    Objective To evaluate the clinical effect of CT-guided percutaneous drainage in the treatment of abdominal abscess.Methods Thirty-two patients were treated with CT puntures percutaneous drainage,aspirated pusflushing the abscess,and set the flow antibiotics.Results Success rate of CT-guided percutaneous drainage therapy was 90.6%.Drainage catheter were kept from 7 to 20 days.No complication occurred in the course of treatment.All the patients' temperature dropped within 2 days,pain relieved,and the abscess volume significantly reduced after a week.Conclusions CT-guided percutaneous catheter drainage in the treatment of abdominal abscess,the operation is simple,accurate and has better safety,efficacy,and it is a worthy interventional treatment.%目的 对CT引导下经皮穿刺引流治疗腹部脓肿的效果进行临床评价.方法 对32例腹部脓肿患者行CT引导下经皮穿刺引流术,抽出脓液,冲洗脓腔,并留置抗生素.结果 CT引导下经皮穿刺引流术成功率为90.6%,引流后带管时间7~20 d,治疗过程中无并发症发生;患者2d内体温下降,疼痛减轻,1周后复查CT,脓肿体积明显缩小.结论 应用CT引导下经皮穿刺导管置入引流术治疗腹部脓肿,操作简单,准确安全,疗效较好,是一种值得推广的介入治疗手段.

  11. CT引导射频消融术治疗股骨颈骨样骨瘤六例%CT-guided radiofrequency ablation for the treatment of osteoid osteoma in femoral neck:preliminary experience in 6 cases

    Institute of Scientific and Technical Information of China (English)

    王玉涛; 汪建华; 王海涛; 于志海; 涂灿; 左长京; 田建明

    2014-01-01

    Objective To evaluate the feasibility, safety and efficacy of CT-guided radiofrequency ablation in treating osteoid osteoma located at femoral neck. Methods Six patients with osteoid osteomas in the femoral neck received CT-guided percutaneous radiofrequency ablation. In all patients the main complaint was pain at the hip, and the course of disease varied from one month to 2 years, with an average of 8 months. Under spinal anesthesia the surgery was performed. With the help of CT guidance , a 3.5 to 4.0 mm coaxial drill system was inserted into the nidus, and an osseous access was established, then the bone biopsy needle was used to obtain specimens for pathological examination. Subsequently, a 1.5 to 2.0 cm active tip was introduced through a non-cooled radiofrequency needle into the nidus. Radiofrequency ablation was performed with the therapeutic temperature of 90℃, lasting for 6 minutes. The pain visual analogue scale (VAS) was used to evaluate the clinical effectiveness. The postoperative MRI findings were compared with the preoperative ones. Results Three days after the treatment, different degrees of pain relief was obtained in all patients, and all patients could get out of bed and walked around in one week. Postoperative VSA was significantly decreased (P<0.01). No severe complications occurred during and after the procedure. And no recurrence was seen during the follow-up period. Conclusion For the treatment of osteoid osteoma located at femoral neck, CT-guided radiofrequency ablation is a safe and effective minimally invasive treatment with fewer complications and satisfactory clinical results.%目的:探讨CT引导下应用射频消融术(RFA)治疗股骨颈骨样骨瘤的可行性、安全性,并评估其疗效。方法对6例股骨颈骨样骨瘤患者采用CT引导下经皮穿刺RFA术治疗。患者均以髋关节疼痛症状为主,病程1个月~2年,平均8个月。手术在腰麻下进行,术中于 CT 引导下应用直径3.5~4

  12. CT-guided radiofrequency ablation of osteoid osteoma and osteoblastoma: Clinical success and long-term follow up in 77 patients

    Energy Technology Data Exchange (ETDEWEB)

    Rehnitz, Christoph, E-mail: Christoph.Rehnitz@med.uni-heidelberg.de [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg (Germany); Sprengel, Simon David, E-mail: SimonDavid.Sprengel@med.uni-heidelberg.de [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg (Germany); Lehner, Burkhard, E-mail: Burkhard.Lehner@med.uni-heidelberg.de [Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, D-69118 Heidelberg (Germany); Ludwig, Karl, E-mail: karl.ludwig@klinikum-herford.de [Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, D-69118 Heidelberg (Germany); Omlor, Georg, E-mail: Georg.Omlor@med.uni-heidelberg.de [Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, D-69118 Heidelberg (Germany); Merle, Christian, E-mail: Christian.Merle@med.uni-heidelberg.de [Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, D-69118 Heidelberg (Germany); Kauczor, Hans-Ulrich, E-mail: HU.Kauczor@med.uni-heidelberg.de [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg (Germany); Ewerbeck, Volker, E-mail: Volker.Ewerbeck@med.uni-heidelberg.de [Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, D-69118 Heidelberg (Germany); Weber, Marc-Andre, E-mail: MarcAndre.Weber@med.uni-heidelberg.de [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg (Germany)

    2012-11-15

    The purpose of this study was to retrospectively evaluate long-term success of CT-guided radiofrequency ablation (RFA) in patients with osteoid osteoma (OO) and osteoblastoma (OB) including tumors in critical locations. Eighty-one CT-guided RFA procedures were performed in 77 patients with OO (65 patients) and OB (12) including 6 spinal and 15 intra/periarticular tumors. Procedural techniques included multiple needle positions, three-dimensional access planning, as well as, thermal protection techniques. Long-term success was assessed using a questionnaire including, among others, several VAS (visual analogue scale) scores. All patients completed 3-6 months follow-up, overall response to the questionnaire was 64/77 (83.1%). Primary success rate was 74/77 (96.1%) of all patients. Retreatment with RFA in 3 patients resulted in a secondary success rate of 77/77 (100%). Long-term follow-up (mean, 38.5 months; range, 3-92) revealed a highly significant (p < 0.001) reduction of all assessed limitation scores reaching normal or almost normal values. One major complication, a cannula break leading to a secondary short hospital stay, occurred. In conclusion, RFA is a safe and effective long-lasting treatment of OO and OB. Advanced procedural techniques aid treating tumors in critical locations and in the coverage of larger tumors. Besides night pain, RFA also greatly improves other factors negatively affecting the quality of life.

  13. Needle-in-Needle Technique for Percutaneous Retrieval of a Fractured Biopsy Needle during CT-Guided Biopsy of the Thoracic Spine.

    Science.gov (United States)

    Shaikh, Hamza; Thawani, Jayesh; Pukenas, Bryan

    2014-10-31

    Common complications related to CT-guided percutaneous thoracic bone biopsy procedures include pneumothorax and muscular hematoma. Serious, but rare complications include paralysis, nerve injury, CSF leak, and aortic injury. Device failure has not been well documented in the literature. We discuss our experience with biopsy needle breakage during retrieval of a core specimen and the technique used to help retrieve an embedded needle using a CT fluoroscopic-guided, needle-in-needle approach. A 43 year-old man with Stage IIIa NSCLC was found to have a T11 vertebral body lesion as seen on PET, CT, and MR imaging. The patient underwent a CT-guided biopsy in the prone position. The T11 vertebral body was localized and cannulated using the percutaneous Bonopty(®) (Apriomed, Upsala, Sweden) needle device. After fine needle aspiration samples were obtained, a core needle biopsy was attempted with a 16-gauge device. The needle fractured 4 cm deep to the skin during removal of a sclerotic lesion, leaving a retained portion within the pedicle and vertebral body. Using CT-guided fluoroscopy, a large diameter Murphy M2 needle was advanced over the distal portion of the fractured Bonopty needle. The Murphy M2 needle was advanced distal to the tip of the Bonopty needle and removed, capturing the broken Bonopty penetration needle along with a core specimen. Larger-bore biopsy needle systems and/or a coaxial system should be used to perform core biopsies in sclerotic lesions to prevent device fracture. If there is device fracture, a larger-bore needle may be used to help capture the fractured needle and prevent open surgery.

  14. CT-guided injection of botulinic toxin for percutaneous therapy of piriformis muscle syndrome with preliminary MRI results about denervative process

    Energy Technology Data Exchange (ETDEWEB)

    Fanucci, E.; Masala, S.; Sodani, G.; Varrucciu, V.; Romagnoli, A.; Squillaci, E.; Simonetti, G. [Dept. of Radiology, Univ. of Rome (Italy)

    2001-12-01

    Piriformis muscle syndrome (PMS) is a cause of sciatica, leg or buttock pain and disability. The pain is usually increased by muscular contraction, palpation or prolonged sitting. The aim of our paper was to evaluate the feasibility of CT-guided percutaneous botulinic toxin (BTX) injection for the purpose of PMS treatment. Thirty patients suffering from PMS, suspected with clinical and electrophysiological criteria, after imaging examinations excluding other causes of sciatic pain, resulted positive at the lidocaine test and were treated by intramuscular injection of BTX type A under CT guidance. The follow-up (12 months) was performed with clinical examination in all cases and with MR 3 months after the procedure in 9 patients to evaluate the denervative process entity of the treated muscle. In 26 cases relief of symptoms was obtained after 5-7 days. In 4 patients an insufficient relief of pain justified a second percutaneous treatment which was clinically successful. No complications or side effects were recorded after BTX injection. The MR examination showed a signal intensity change of the treated muscle in 7 patients due to the denervative process of PM, whereas in the remaining 2 cases only an atrophy of the treated muscle was detected. Larger series are necessary to confirm these MRI preliminary results. The CT-guided BTX injection in the PMS is an emergent and feasible technique that obtains an excellent local therapeutic effect without risk of imprecise inoculation. (orig.)

  15. Laser Guidance in C-Arm Cone-Beam CT-Guided Radiofrequency Ablation of Osteoid Osteoma Reduces Fluoroscopy Time

    NARCIS (Netherlands)

    Kroes, M.W.; Busser, W.M.H.; Hoogeveen, Y.L.; Lange, F. de; Schultze Kool, L.J.

    2017-01-01

    PURPOSE: To assess whether laser guidance can reduce fluoroscopy and procedure time of cone-beam computed tomography (CBCT)-guided radiofrequency (RF) ablations of osteoid osteoma compared to freehand CBCT guidance. MATERIALS AND METHODS: 32 RF ablations were retrospectively analyzed, 17

  16. CT-guided percutaneous fine-needle aspiration biopsy of pulmonary nodules measuring 10 mm or less

    Energy Technology Data Exchange (ETDEWEB)

    Ng, Y.L. [Joint Department of Medical Imaging, Thoracic Division, University Health Network and Mount Sinai Hospital, Toronto, Ontario (Canada)], E-mail: yuenli_ng@hotmail.com; Patsios, D.; Roberts, H.; Walsham, A.; Paul, N.S.; Chung, T.; Herman, S.; Weisbrod, G. [Joint Department of Medical Imaging, Thoracic Division, University Health Network and Mount Sinai Hospital, Toronto, Ontario (Canada)

    2008-03-15

    Aim: To determine the value of computed tomography (CT)-guided fine-needle aspiration biopsy (FNAB) of small pulmonary nodules measuring 10 mm or less. Material and Methods: CT-guided FNABs of 55 nodules, measuring 10 mm or less, were performed between January 2003 and February 2006. A coaxial technique was used, with an outer 19 G Bard Truguide needle and inner 22 G disposable Greene biopsy needle. Adequacy of specimens was assessed on-site by a cytotechnologist. The sizes of the nodules, distance from pleura, number of pleural punctures and aspirates, complications encountered, cytological diagnosis, and outcome were recorded. Results: The mean nodule diameter was 9 mm (range 5-10 mm). The average distance from the costal pleura was 31 mm (range 0-88 mm). In 50 of the 55 FNABs, the pleura was crossed once. An average of four aspirates was performed per case. Twenty-five FNABs (45.5%) were adequate for diagnosis (24 malignant and one tuberculosis). In 11 cases, where no definite diagnosis was made following FNAB, the outcome was not affected. In 10 cases, samples were insufficient for diagnosis and the nodules were subsequently diagnosed as malignant. Eight cases were excluded in the final analysis as follow-up details were unavailable. The sensitivity for malignancy and overall accuracy were 67.7 and 78.8%, respectively. Pneumothorax occurred in 29 (52.7%) patients, with five (9.1%) requiring thoracostomy tubes. Conclusion: CT-guided FNAB is a useful tool in the diagnosis and management of small pulmonary nodules, despite the lower diagnostic accuracy and higher complication rate than those of larger pulmonary lesions.

  17. CT-guided percutaneous catheter drainage in thetreatment of liverabscess%CT 引导经皮穿刺置管引流治疗肝脓肿

    Institute of Scientific and Technical Information of China (English)

    卢占兴; 陈新晖

    2014-01-01

    Objective To investigate the method and curative effect of the CT-guided percutaneous catheter drainage in hepatic ab-scess.Methods 36 patients with liver abscess were treated with “one-step”percutaneous 8F pig tail catheter tube under CT guidance. Results 36 patients were performed “one-step”percutaneous catheter drainage,the successful rate was 100%,no severe complica-tions occurred.Symptoms were improved after cathetering in all patients.Of these 36 patients,30 patients had single abscess and 6 patients had multiple abscesses.The mean duration of drainage catheterization was 21.2 days for 36 patients.The diameter of ab-scess was between 4.0-1 9.5 cm,the mean diameter of abscess was 8.3 cm.Conclusion CT-guided percutaneous hepatic abscess catheter drainage is a safe,effective,minimally-invasive treatment.%目的:探讨 CT 引导下经皮穿刺置管引流治疗肝脓肿的方法和疗效。方法对36例肝脓肿患者行 CT 引导下经皮穿刺放置8F 猪尾巴引流管持续引流。结果36例采用“一步法”穿刺均1次穿刺置管成功,无严重并发症发生,全部患者置管引流治疗后症状得到改善。30例为单一病灶,6例为多发病灶;平均引流置管时间为21.2 d。脓肿最大径为4.0~19.5 cm,平均8.3 cm。结论肝脓肿 CT 引导下置管治疗是一种安全、有效、微创且易被患者接受的治疗方法。

  18. CT-guided brachytherapy. A novel percutaneous technique for interstitial ablation of liver malignancies; CT-gesteuerte Brachytherapie. Eine neue perkutane Technik zur interstitiellen Ablation von Lebermetastasen

    Energy Technology Data Exchange (ETDEWEB)

    Ricke, J.; Wust, P.; Stohlmann, A.; Beck, A.; Cho, C.H.; Pech, M.; Wieners, G.; Spors, B.; Werk, M.; Rosner, C.; Haenninen, E.L.; Felix, R. [Klinik fuer Strahlenheilkunde, Charite Virchow-Klinikum, Humboldt-Univ. zu Berlin (Germany)

    2004-05-01

    Purpose: to assess safety and efficacy of CT-guided brachytherapy of liver malignancies. Patients and methods: 21 patients with 21 liver malignancies (19 metastases, two primary liver tumors) were treated with interstitial CT-guided brachytherapy applying a {sup 192}Ir source. In all patients, the use of image-guided thermal tumor ablation such as by radiofrequency or laser-induced thermotherapy (LITT) was impeded either by tumor size {>=} 5 cm in seven, adjacent portal or hepatic vein in ten, or adjacent bile duct bifurcation in four patients. Dosimetry was performed using three-dimensional CT data sets acquired after CT-guided positioning of the brachytherapy catheters. Results: the mean tumor diameter was 4.6 cm (2.5-11 cm). The mean minimal tumor dose inside the tumor margin amounted to 17 Gy (12-20 Gy). The proportion of the liver parenchyma exposed to > 5 gy was 18% (5-39%) of total liver parenchyma minus tumor volume. Nausea and vomiting were observed in six patients after brachytherapy (28%). One patient demonstrated obstructive jaundice due to tumor edema after irradiation of a metastasis adjacent to the bile duct bifurcation. We commonly encountered asymptomatic increases of liver enzymes. Local control rates after 6 and 12 months were 87% and 70%, respectively. Conclusion: CT-guided brachytherapy is safe and effective. This technique displays broader indications compared to image-guided thermal ablation by radiofrequency or LITT with respect to tumor size or localization. (orig.) [German] Ziel: Analyse der Sicherheit und Effektivitaet CT-gesteuerter Brachytherapie zur Ablation von Lebermalignomen. Patienten und Methodik: 21 Patienten mit 21 Lebermalignomen (19 Metastasen, zwei primaere Lebermalignome) wurden mit perkutaner, CT-gesteuerter interstitieller Brachytherapie mit {sup 192}Ir behandelt. Alle Patienten wiesen Umstaende auf, die eine bildgefuehrte thermische Ablation mit Radiofrequenz oder laserinduzierter Thermotherapie (LITT) einschraenkten

  19. Treatment of 213 Patients with Symptomatic Tarlov Cysts by CT-Guided Percutaneous Injection of Fibrin Sealant.

    Science.gov (United States)

    Murphy, K; Oaklander, A L; Elias, G; Kathuria, S; Long, D M

    2016-02-01

    There has been a steady progression of case reports and a small surgical series that report successful surgical treatment of Tarlov cysts with concomitant relief of patients' symptoms and improvement in their neurological dysfunction, yet patients are still told that these lesions are asymptomatic by physicians. The purpose of this study was to analyze the efficacy and safety of intervention in 213 consecutive patients with symptomatic Tarlov cysts treated by CT-guided 2-needle cyst aspiration and fibrin sealing. This study was designed to assess outcomes in patients who underwent CT-guided aspiration and injection of ≥1 sacral Tarlov cyst at Johns Hopkins Hospital between 2003 and 2013. In all, 289 cysts were treated in 213 consecutive patients. All these patients were followed for at least 6 months, 90% were followed for 1 year, and 83% were followed for 3-6 years. The aspiration-injection procedure used 2 needles and was performed with the patients under local anesthesia and intravenous anesthesia. In the fibrin-injection stage of the procedure, a commercially available fibrin sealant was injected into the cyst through the deep needle (Tisseel VH). One year postprocedure, excellent results were obtained in 104 patients (54.2% of patients followed), and good or satisfactory results were obtained in 53 patients (27.6%). Thus, 157 patients (81.8%) in all were initially satisfied with the outcome of treatment. At 3-6 years postprocedure, 74.0% of patients followed were satisfied with treatment. There were no clinically significant complications. The aspiration-injection technique described herein constitutes a safe and efficacious treatment option that holds promise for relieving cyst-related symptoms in many patients with very little risk. © 2016 by American Journal of Neuroradiology.

  20. CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes

    Institute of Scientific and Technical Information of China (English)

    Chang-Jing Zuo; Pei-Jun Wang; Cheng-Wei Shao; Min-Jie Wang; Jian-Ming Tian; Yi Xiao; Fang-Yuan Ren; Xi-Yan Hao; Min Yuan

    2004-01-01

    AIM: To explore the feasibility of computed tomography (CT)-guided percutaneous ethanol injection (PEI) using a disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes.METHODS: CT-guided PEI was conducted using a disposable curved needle in 26 malignant liver tumors smaller than 5 cm in diameter and 5 lymph node metastases of liver cancer in the retroperitoneal space. The disposable curved needle was composed of a straight trocar (21G) and stylet, a disposable curved tip (25 G) and a fine stylet. For the tumors found in deep sites and difficult to reach, or for hepatic masses inaccessible to the injection using a straight needle because of portal vein and bile ducts, the straight trocar was used at first to reach the side of the tumor. Then, the disposable curved needle was used via the trocar. When the needle reached the tumor center, appropriate amount of ethanol was injected. For relatively large malignant liver tumors,multi-point injection was carried out for a better distribution of the ethanol injected throughout the masses. The curved needle was also used for treatment of the metastasis in retroperitoneal lymph nodes blocked by blood vessels and inaccessible by the straight needle.RESULTS: All of the 26 liver tumors received 2 or more times of successful PEI, through which ethanol was distributed throughout the whole tumor mass. Effect of the treatment was monitored by contrast-enhanced multi-phase CT and magnetic resonance imaging (MRI) examinations three months later. Of the 18 lesions whose diameters were smaller than 3 cm, the necrotic change across the whole mass and that in most areas were observed in 15 and 3 tumors,respectively. Among the 8 tumors sizing up to 3 cm, 5 were completely necrotic and 3 largely necrotic. Levels of tumor seromarkers were significantly reduced in some of the cases.In 5 patients with metastases of liver cancer in retroperitoneal lymph nodes who received 1 to 3

  1. CT-guided percutaneous screw fixation plus cementoplasty in the treatment of painful bone metastases with fractures or a high risk of pathological fracture

    Energy Technology Data Exchange (ETDEWEB)

    Pusceddu, Claudio; Ballicu, Nicola; Fele, Rosa Maria; Sotgia, Barbara; Melis, Luca [Oncological Hospital ' ' A. Businco' ' , Regional Referral Center for Oncologic Diseases, Division of Interventional Radiology, Department of Oncological Radiology, Cagliari (Italy); Fancellu, Alessandro [University of Sassari, Department of Clinical and Experimental Medicine, Sassari (Italy)

    2017-04-15

    To evaluate the feasibility and effectiveness of computed tomography (CT)-guided percutaneous screw fixation plus cementoplasty (PSFPC), for either treatment of painful metastatic fractures or prevention of pathological fractures, in patients who are not candidates for surgical stabilization. Twenty-seven patients with 34 metastatic bone lesions underwent CT-guided PSFPC. Bone metastases were located in the vertebral column, femur, and pelvis. The primary end point was the evaluation of feasibility and complications of the procedure, in addition to the length of hospital stay. Pain severity was estimated before treatment and 1 and 6 months after the procedure using the visual analog scale (VAS). Functional outcome was assessed by improved patient walking ability. All sessions were completed and well tolerated. There were no complications related to either incorrect positioning of the screws during bone fixation or leakage of cement. All patients were able to walk within 6 h after the procedure and the average length of hospital stay was 2 days. The mean VAS score decreased from 7.1 (range, 4-9) before treatment to 1.6 (range, 0-6), 1 month after treatment, and to 1.4 (range 0-6) 6 months after treatment. Neither loosening of the screws nor additional bone fractures occurred during a median follow-up of 6 months. Our results suggest that PSFPC might be a safe and effective procedure that allows the stabilization of the fracture and the prevention of pathological fractures with significant pain relief and good recovery of walking ability, although further studies are required to confirm this preliminary experience. (orig.)

  2. PET/CT-guided percutaneous biopsy of FDG-avid metastatic bone lesions in patients with advanced lung cancer: a safe and effective technique

    Energy Technology Data Exchange (ETDEWEB)

    Guo, Wei; Hao, Bing; Chen, Hao-jun; Zhao, Long; Luo, Zuo-ming; Wu, Hua; Sun, Long [The First Affiliated Hospital of Xiamen University, Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Hospital, Xiamen (China)

    2017-01-15

    {sup 18}F-FDG PET/CT should be performed before a diagnostic biopsy site is chosen in patients with a high clinical suspicion of aggressive, advanced tumour. The aim of this study was to evaluate the safety and efficacy of {sup 18}F-FDG PET/CT in guiding biopsy of bone metastases in patients with advanced lung cancer. PET/CT-guided percutaneous core biopsies were performed in 51 consecutive patients with suspected lung cancer and {sup 18}F-FDG-avid bone lesions after whole-body {sup 18}F-FDG PET/CT scans. Generally, one tissue sample was obtained from each patient. The final diagnoses were established on the basis of the histology results. The histopathological and molecular testing results were systematically evaluated. A total of 53 samples were obtained for histological examination or molecular testing as a second biopsy was required in two patients in whom the pathological diagnosis was unclear following the first biopsy. The pathological diagnosis and lung cancer classification were confirmed in 48 patients. The epidermal growth factor receptor mutation status was determined in 23 biopsies, and the mutation rate was 30.4 % (7/23). The anaplastic lymphoma kinase mutation status was determined in 19 biopsies, and the mutation rate was 31.6 % (6/19). Two of the 51 biopsies were positive for non-Hodgkin's lymphoma and one was positive for metastatic renal cell carcinoma. The first-time diagnostic success rate of biopsy was 96.1 % (49/51) and the overall diagnostic success rate and sensitivity were 100 %. All 51 patients were eventually confirmed as having stage IV disease. No serious complications were encountered and the average biopsy time was 30 min. PET/CT-guided percutaneous biopsy of {sup 18}F-FDG-avid bone metastases is an effective and safe method that yields a high diagnostic success rate in the evaluation of hypermetabolic bone lesions in patients with suspected advanced lung cancer. (orig.)

  3. Graphics Processing Unit-Accelerated Nonrigid Registration of MR Images to CT Images During CT-Guided Percutaneous Liver Tumor Ablations.

    Science.gov (United States)

    Tokuda, Junichi; Plishker, William; Torabi, Meysam; Olubiyi, Olutayo I; Zaki, George; Tatli, Servet; Silverman, Stuart G; Shekher, Raj; Hata, Nobuhiko

    2015-06-01

    Accuracy and speed are essential for the intraprocedural nonrigid magnetic resonance (MR) to computed tomography (CT) image registration in the assessment of tumor margins during CT-guided liver tumor ablations. Although both accuracy and speed can be improved by limiting the registration to a region of interest (ROI), manual contouring of the ROI prolongs the registration process substantially. To achieve accurate and fast registration without the use of an ROI, we combined a nonrigid registration technique on the basis of volume subdivision with hardware acceleration using a graphics processing unit (GPU). We compared the registration accuracy and processing time of GPU-accelerated volume subdivision-based nonrigid registration technique to the conventional nonrigid B-spline registration technique. Fourteen image data sets of preprocedural MR and intraprocedural CT images for percutaneous CT-guided liver tumor ablations were obtained. Each set of images was registered using the GPU-accelerated volume subdivision technique and the B-spline technique. Manual contouring of ROI was used only for the B-spline technique. Registration accuracies (Dice similarity coefficient [DSC] and 95% Hausdorff distance [HD]) and total processing time including contouring of ROIs and computation were compared using a paired Student t test. Accuracies of the GPU-accelerated registrations and B-spline registrations, respectively, were 88.3 ± 3.7% versus 89.3 ± 4.9% (P = .41) for DSC and 13.1 ± 5.2 versus 11.4 ± 6.3 mm (P = .15) for HD. Total processing time of the GPU-accelerated registration and B-spline registration techniques was 88 ± 14 versus 557 ± 116 seconds (P computation time despite the difference in the complexity of the algorithms (P = .71). The GPU-accelerated volume subdivision technique was as accurate as the B-spline technique and required significantly less processing time. The GPU-accelerated volume subdivision technique may enable the implementation of nonrigid

  4. Long-term results after CT-guided percutaneous ethanol ablation for the treatment of hyper functioning adrenal disorders

    Energy Technology Data Exchange (ETDEWEB)

    Frenk, Nathan Elie; Sebastianes, Fernando; Lerario, Antonio Marcondes; Fragoso, Maria Candida Barisson Villares; Mendonca, Berenice Bilharinho [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina; Menezes, Marcos Roberto de, E-mail: menezesmr@gmail.com [Instituto do Cancer do Estado de Sao Paulo, SP (Brazil)

    2016-10-15

    Objectives: To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyper functioning adrenal disorders. Method: We retrospectively evaluated the long-term results of nine patients treated with computed tomography guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macro nodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years. Results: Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macro nodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients. Conclusion: Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyper functioning adrenal disorders and is not without risks. (author)

  5. Long-term Results after CT-Guided Percutaneous Ethanol Ablation for the Treatment of Hyperfunctioning Adrenal Disorders

    Directory of Open Access Journals (Sweden)

    Nathan Elie Frenk

    Full Text Available OBJECTIVES: To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyperfunctioning adrenal disorders. METHOD: We retrospectively evaluated the long-term results of nine patients treated with computed tomography-guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macronodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years. RESULTS: Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macronodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients. CONCLUSION: Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyperfunctioning adrenal disorders and is not without risks.

  6. CT引导下射频消融术治疗肝癌的临床效果评价%The Clinical Effect Assessment of CT-guided Radiofrequency Ablation(RFA)in Treatment of Liver Cancer

    Institute of Scientific and Technical Information of China (English)

    曾智明; 朱广志

    2014-01-01

    Objective:To explore and evaluate the clinical effect of CT-guided radiofrequency ablation(RFA) in treatment of liver cancer.Method:60 patients who were treated by CT-guided radiofrequency ablation(RFA)in our hospital from April 2012 to April 2013 were selected,and the clinical efficacy and prognosis of CT-guided radiofrequency ablation(RFA)in treatment of 60 liver cancer patients were explored and analyzed.Result:There had no significant differences in blood pressure,pulse and blood oxygen saturation between preoperative and intraoperative (P>0.05).After treatment,the average value of AFP and CEA were significantly lower than before treatment,the differences were statistically significant(P0.05),而治疗后平均AFP和CEA检测值均明显低于治疗前,差异均有统计学意义(P<0.05)。60例患者肿瘤完全坏死56例,占93.3%;不完全坏死3例,占5.0%;部分坏死1例,占1.7%。60例患者在1年内复发16例,占26.7%;1年内死亡患者1例,存活59例,1年生存率为98.3%。结论:CT引导下射频消融术(RFA)治疗肝癌的临床效果良好,值得在临床上推广。

  7. CT-guided semilunar ganglion radiofrequency thermocoagulation in treatment of trigeminal neuralgia%CT引导下半月神经节射频热凝治疗三叉神经痛

    Institute of Scientific and Technical Information of China (English)

    杨云春; 王昭斌; 武百山

    2011-01-01

    Objective To observe and analyze therapeutic effect by CT-guided semilunar ganglion radiofrequency thermocougulation in treatment trigeminal neuralgia. Methods 40 patients with trigeminal neuralgia received CT-guided semilunar ganglion apuncture, and then radiofrequency thermocougulation were performed under the thermal controlled from 65 to 80 ℃ and continued 3 minutes for 3 to 4 times. Results Pain was completed eliminated in 32 of the 40 patients, which was regarded as degree Ⅰ. 5 cases was of degree Ⅱ . 2 case was of degree Ⅲ. 1 case had no effect. The rate of satisfactory effectiveness was 92. 5% and the total rate of efficacy was 97.5%. Conclusion CT-guided semilunar ganglion radiofrequency thermocoagulation in treatment of trigeminal neuralgia is safe and effective to treat trigeminal neuralgia.%目的 观察CT引导下半月神经节射频热凝术治疗原发性三又神经痛的临床疗效.方法 40例三叉神经痛患者在CT引导下,经前入路法穿刺三又神经半月节后行射频热凝毁损治疗,温度控制在65~80℃持续时间3min,共3~4次.结果 40例患者中,32例疗效I级,5例疗效Ⅱ,2例疗效Ⅲ级;一次性治疗显效率92.5%,总有效率97.5%.1例为Ⅳ级无效.结论 CT引导行三又神经半月神经节射频热凝术是一种安全、可靠、有效的微创治疗技术,具有临床推广应用价值.

  8. Computed tomography-guided percutaneous radiofrequency thermocoagulation for primary trigeminal neuralgia in older and younger patients

    Institute of Scientific and Technical Information of China (English)

    Guanghui Lai; Jiaxiang Ni; Baishan Wu; Mingwei He; Liqiang Yang; Jianning Yue; Yuna Guo

    2011-01-01

    We evaluated the immediate and long-term clinical efficacy of computed tomography (CT)-guided radiofrequency thermocoagulation for primary trigeminal neuralgia (RTPTN) in 852 patients includ-ing 502 patients aged ≥ 60 years and 350 patients aged < 60 years. After discharge, the incidence of complications was 1.0% and 0.9% in patients aged ≥ 60 years and patients aged < 60 years, respectively. Over 3-year follow-up after CT-guided RTPTN, 96.8% of the patients aged ≥ 60 years and 98.6% of the patients aged < 60 years were completely pain-free, and there was no significant difference between these two age brackets. In addition, there were no significant differences in quality of life scores and numbness scores between these two age brackets. These findings suggest that CT-guided RTPTN is a safe and effective method and is recommended for older and poor-risk patients.

  9. Perioperative nursing of children in CT-guided radiofrequency ablation of osteoid osteoma%CT引导下骨样骨瘤射频消融术患儿的围手术期护理

    Institute of Scientific and Technical Information of China (English)

    黄晓清; 古宏文; 杨叶香; 陈碧英

    2011-01-01

    Objective To sulnmarize the perioperative nursing experience of CT-guided radiofrequency ablation of fight tibia osteoid osteoma in children.Methods One case of CT-guided radiofrequency ablation was clinically observed and nursed.Results The patient underwent a successful surgery without complications,healing well.Condusions Good psychological care,safety care before the operation and improved preoperative preparation are the key to make sure that the operation goes smoothly.Strengthening the observation and care after surgery could effectively reduce complications and improve cure rate.%目的 总结CT引导下右胫骨骨样骨瘤射频消融术患儿的围手术期护理经验.方法 通过对1例需要行CT引导下射频消融治疗的患儿进行临床观察和护理.结果 该例患儿手术成功、无并发症发生,愈合良好.结论 术前做好心理护理、安全护理,以及完善各项术前准备是保证手术顺利进行的关键.术后加强观察和护理可有效减少各种并发症,提高治愈率.

  10. CT-guided percutaneous cryoablation of osteoid osteoma%CT导向下冷冻消融术治疗儿童骨样骨瘤

    Institute of Scientific and Technical Information of China (English)

    张肖; 肖越勇; 杨杰; 吴斌; 马旭阳; 刘士榕; 任超

    2011-01-01

    Objective To evaluate the safety and efficacy of the CT-guided percutaneous cryoablation of osteoid osteoma in children.Methods Nine children with osteoid osteoma proved by histopathology were treated with CT-guided cryoablation from January 2007 to January 2010.There were 6 boys and 3 girls.Their mean age was ( 13.0 + 1.6 ) years ( ranging from 10.0-15.0 years ).The procedures were performed under local anesthesia.Eight G bone biopsy needles for biopsy and 17 G freezing needles were used in the procedure.CT guidance was used for procedural planning,instrument guidance,and monitoring.Each cryoablation included two freezing-thawing cycles.Follow-up was performed to assess technical and clinical outcome.A visual analog scale (VAS) was used to assess severity of pain pre- and post-procedure,and mean VAS for the group was compared pre- and post-procedure with Kruskal-Wallis rank sum test.Results Biopsy and cryoablation were successfully performed in all children.No major immediate or postponed complications were observed.Significant pain relief ( P < 0.01 ) was observed in all patients after procedure.The VAS of preoperation(8 points 1 case,7 points 3 cases,6 points 4 cases,5 points 1 case) compared with that of one month after operation ( 1 point 4 cases,0 point 5 cases),the difference was statistically significant( H =32.838,P < 0.01 ).These patients were allowed to fully weight-bear and function without limitation 3 days after the procedure.Pain was obviously released.Pain recurrence was not observed in all patients.Moderate fever (37.8 ℃ ) was observed in a patient one day after operation and fully recovered 2 days later.Conclusion CT-guided percutaneous cryoablation is a safe and effective minimally invasive method for the treatment of osteoid osteoma in children.%目的 评估CT导向下冷冻消融术治疗儿童骨样骨瘤的安全性及有效性.方法 2007年1月至2010年1月期间,对9例病理证实的骨样骨瘤儿童患者行CT导向

  11. CT-guided percutaneous neurolysis methods. State of the art and first results; CT-gesteuerte Neurolysen. Stand der Technik und aktuelle Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, B. [Abt. Radiodiagnostik, Radiologische Universitaetsklinik Heidelberg (Germany); Richter, G.M. [Abt. Radiodiagnostik, Radiologische Universitaetsklinik Heidelberg (Germany); Roeren, T. [Abt. Radiodiagnostik, Radiologische Universitaetsklinik Heidelberg (Germany); Kauffmann, G.W. [Abt. Radiodiagnostik, Radiologische Universitaetsklinik Heidelberg (Germany)

    1996-09-01

    We used 21G or 22G fine needles. All CT-guided percutaneous neurolysis methods require a proper blood coagulation. Most common CT scanners are suitable for neurolysis if there is enough room for maintaining sterile conditions. All neurolysis methods involve sterile puncture of the ganglia under local anesthesia, a test block with anesthetic and contrast agent to assess the clinical effect and the definitive block with a mixture of 96% ethanol and local anesthetic. This allows us to correct the position of the needle if we see improper distribution of the test block or unwanted side effects. Though inflammatory complications of the peritoneum due to puncture are rarely seen, we prefer the dorsal approach whenever possible. Results: Seven of 20 legs showed at least transient clinical improvement after CT-guided lumbar sympathectomies; 13 legs had to be amputated. Results of the methods in the literature differ. For lumbar sympathectomy, improved perfusion is reported in 39-89%, depending on the pre-selection of the patient group. Discussion: It was recently proved that sympathectomy not only improves perfusion of the skin but also of the muscle. The hypothesis of a steal effect after sympathectomy towards skin perfusion was disproved. Modern aggressive surgical and interventional treatment often leaves patients to sympathectomy whose reservers of collateralization are nearly exhausted. We presume this is the reason for the different results we found in our patient group. For thoracic sympathectomy the clinical treatment depends very much on the indications. Whereas palmar hyperhidrosis offers nearly 100% success, only 60-70% of patients with disturbance of perfusion have benefited. Results in celiac ganglia block also differ. Patients with carcinoma of the pancreas and other organs of the upper abdomen benefit in 80-100% of all cases, patients with chronic pancreatitis in 60-80%. (orig./VHE) [Deutsch] Thorakale und lumbale Sympathikolyse sowie die Zoeliakusblockade

  12. Clinical efficacy of CT-guided percutaneous huge ilio-psoas abscesses drainage combined with posterior approach surgery for the management of dorsal and lumbar spinal tuberculosis in adults.

    Science.gov (United States)

    Zou, Authrors Dexin; Zhou, Junlin; Zhou, Xiaobin; Jiang, Xiaobing

    2017-09-12

    To evaluate the clinical efficacy of CT-guided percutaneous huge ilio-psoas abscesses drainage combined with posterior approach surgery for the management of dorsal and lumbar spinal tuberculosis in 16 adult cases. Between January 2006 and June 2013, a total of 16 dorsal and lumbar spinal tuberculosis patients with huge ilio-psoas abscesses underwent two-stage CT-guided percutaneous abscesses drainage and posterior debridement, decompression, intervertebral fusion and instrumentation. Standard quadruple antituberculous chemotherapy was performed both before and after surgery. The average follow-up period was 26.7 months (range 18-38 months). There is no severe complication and relapse of spinal tuberculosis. The blood loss was 921.0±141.3mL, operation time was 174.8±15.7minutes. Kyphotic angle improved from 36.6±10.0° preoperatively to 8.1±1.8° postoperatively with 2.2±1.5° loss of correction at final follow-up. The solid bone fusion was achieved in all cases at average 6.6±2.2 months after surgery. Neurologic deficits were recovered in varing degrees except 4 cases remained the same. The postoperative quality of life significantly improved. The Oswestry Disability Index (ODI) decreased from 32.8±10.6 preoperatively to 14.4±7.9 at the final follow-up. CT-guided percutaneous drainage combined with posterior approach surgery was proved to be safe and effective for the management of dorsal and lumbar spinal tuberculosis with huge ilio-psoas abscesses in adults. Level IV, retrospective. Copyright © 2017. Published by Elsevier Masson SAS.

  13. Perioperative nursing care and follow-up for 118patients with liver abscess treated by CT-guided percutaneous drainage%CT引导下肝脓肿引流的围手术期护理及随访

    Institute of Scientific and Technical Information of China (English)

    虞岑琳; 曹传武; 潘慧; 李茂全

    2014-01-01

    Objective To investigate the perioperative effective nursing method for patients with liver abscess treated by CT-guided percutaneous drainage Methods Giving perioperative nursing care for 118 patients diagnosed with liver abscess treated by CT-guided percutaneous drainage, as lfushing drainage tube with antibiotics, abserving the condition of drainage lfuid till the absence of vomica and uprooting the tube. Results Out of the 118 patients, 114 patients received imaging examination which conifrmed the absence of vomica and abscess, and discharged with normal body temperature. Conclution Thorough nursing care is critical to the effectiveness of patient with liver abscess treated by CT-guided percutaneous drainage.%目的:探讨在CT引导下肝脓肿穿刺引流术患者的有效护理方法。方法:对118例确诊为肝脓肿的患者做好CT引导下穿刺引流术前护理,每日用抗生素反复冲洗,观察引流液的情况,直至脓腔消失,拔除引流管。结果118例肝脓肿患者,其中114例均影像学检查,脓腔消失,脓肿明显消失,体温正常,痊愈出院。结论周密细致的护理工作对CT引导穿刺引流治疗肝脓肿患者的治疗起到关键性的作用。

  14. Minimally invasive CT guided treatment of intraspinal synovial cyst

    National Research Council Canada - National Science Library

    Sergeja Kozar; Miran Jeromel

    2014-01-01

    .... Percutaneous CT guided lumbar synovial cyst treatment is safe and reliable alternative to the surgical treatment in polymorbid patients with radiculopathy who are not able to tolerate general anesthesia and operation.

  15. Usefulness of CT-Guided Percutaneous Catheter Drainage Using a Modified Version of the Seldinger Technique for the Treatment of Intra-abdominal Small Abscess and Poorly Depicted Fluid Collection on Sonogram

    Energy Technology Data Exchange (ETDEWEB)

    Song, Chi Sung [Boramae Hospital, Seoul (Korea, Republic of)

    2010-10-15

    To evaluate the usefulness of CT-guided percutaneous catheter drainage (PCD) using a modified version of the Seldinger technique for deep-seated, small abscesses and poorly depicted fluid collection on abdominal sonogram. Fifty-nine cases of CT-guided PCD were performed on 56 patients. Four techniques were applied to secure safe access routes, which include scan postural change, angulation of the gantry, traversal of organs, and using a dissecting needle which can push the intervening bowel. Three landmarks (depth of the front and back wall of the fluid collection and the end point of catheter advancement over the guide wire) were indicated on the drainage catheter for extracorporeal direct observation of moving distance and location of the catheter during the insertion process. The technical success rate, clinical outcome, complications, and instrumental impairments were reviewed. The technical success rate was 100% (59/59), and no grave complications occurred. Four cases (7%) of crooked guide wire insertion were noted. The clinical outcome revealed a 95% (56/59) successful treatment rate and a 5% (3/59) failed treatment rate, which was caused by undissolved hematoma (1/59) and fistula (2/59). The results of this study suggest that CT-guided PCD using a modified version of the Seldinger technique for deep-seated, small abscesses and poorly depicted fluid collections on an abdominal sonogram is useful in terms of accuracy and safety.

  16. Effect of percutaneous radiofrequency thermocoagulation on different neuropathic pains

    Institute of Scientific and Technical Information of China (English)

    Youcai Shi; Xiaoxia Hu

    2006-01-01

    BACKGROUND: The clinical treatment of neuropathic pain is very troublesome ,and the physical method of radiofrequency thermocoagulation is a good choice for its treatment.OBJECTIVE: To observe the curative effact of percutaneous radiofrequency thermocoagulation on neuropathic neuralgia.DESIGN:A case follow-up analysis.SETTING: Minimally Invasive Surgery Room,Department of Neurosurgery,Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA.PARTICIPANTS: Totally 131 patients were selected from the Department of Neurosurgery,Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA from December 2000 to June 2006,including 73 males and 58 females,aging 37-72 years old,AND the disease course was 2-15 years.①Drug treatment failed to alleviate the pain or induced obvious side the pain or induced obvious side effects; ②With the same pathological changes as pain and effective in the nerve block test; Had signed the informed consents before treatment.Distribution of the neuropathic pain:①Trigeminal neuralgia,which were lighting attack,located at V2 in 28 cases,V3 in 46 cases,V1+V2 in 3 cases,V2+V3 in 28 cases,and V1+V2+V3 in 1 cases;②Migraine located at(except the frontal branch of trigeminal nerve)greater and lesser occipital nerves in 6 cases,auriculotemporal nerve in 3 cases,temporal and zygomatic nerves in 3 cases;③Unilateral neuralgia of C2 and C3 following herpes zoster in 1 case,and chest intercostals neuralgia in 2 cases;④Lasting burning pain in the operative area after thoracotomy was in 1 case of lung cancer.METHODS: ①All the enrolled patients were treated with percutaneous puncture at trigeminal ganglion or peripheral nerve,then nerve block was performed firstly for anesthesia,and the pain disappeared immediately at this moment,there was hypoesthesia or numbness in the area of innervation,which manifested the puncture apposition was correct.then electrostimulation of 50 Hz with the current of 0.1-0.5 V was given for

  17. Treatment of Spinal Osseous Metastasis with Combined Percutaneous Radiofrequency Ablation and Vertebroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Huh, Sik; Hong, Suk Joo; Kim, Ye Lim; Bae, Hyoung Ju; Kang, Eun young [Dept. of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Kim, Joo Han [Dept. of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of)

    2011-04-15

    Recent introduction of image-guided percutaneous methods to treat unresectable bone tumors including metastases that do not respond to conventional radiotherapy or chemotherapy has proven to be effective. Here we present three successfully treated cases of metastatic bone lesions: two cases of malignant bone metastases in the lumbar spine and one in the sacral bone, using combined percutaneous radiofrequency ablation and percutaneous vertebroplasty/compassionately. A brief review of literature is also included.

  18. CT-guided core biopsy and percutaneous fiducial seed placement in the lung: Can these procedures be combined without an increase in complication rate or decrease in technical success?

    Energy Technology Data Exchange (ETDEWEB)

    Mendiratta-Lala, Mishal [Henry Ford Hospital, Department of Radiology, Abdominal Interventional Radiology, 2799 West Grand Blvd, Detroit, MI 48202 (United States); Sheiman, Robert, E-mail: rsheiman@bidmc.harvard.edu [Beth Israel Deaconess Hospital, Department of Radiology, Abdominal Imaging, One Deaconess Road, Boston, MA 02215 (United States); Brook, Olga R. [Beth Israel Deaconess Hospital, Department of Radiology, Abdominal Imaging, One Deaconess Road, Boston, MA 02215 (United States); Gourtsoyianni, Sofia [King' s College London, St Thomas’ Hospital, Lambeth Palace Road, SE1 7EH London (United Kingdom); Mahadevan, Anand [Beth Israel Deaconess Hospital, Radiation Oncology, One Deaconess Road, Boston, MA 02215 (United States); Siewert, Bettina [Beth Israel Deaconess Hospital, Department of Radiology, Abdominal Imaging, One Deaconess Road, Boston, MA 02215 (United States)

    2014-04-15

    Objective: To determine if concomitant CT-guided biopsy and percutaneous fiducial seed placement in the lung can be performed in a selective patient population without increased complication or decreased success rates compared to either procedure alone. Materials and methods: An IRB approved retrospective analysis of 285 consecutive patients that underwent CT-guided placement of fiducial seeds in the lung alone (N = 63), with concomitant core biopsy (N = 53) or only core biopsy (N = 169) was performed. Variables compared included: patient demographics, lesion size, depth from pleura, needle size, number of passes through pleura, number and size of core biopsies, number of seeds placed and technical success rates. Statistical analysis was performed using univariate and multivariate pair-wise comparisons. Results: A pathologic diagnosis of malignancy was confirmed in all cases undergoing seed placement alone and seed placement with concurrent biopsy, and in 144 of the biopsy alone lesions. On univariate analysis, major complication rates were similar for all three groups as were lesion size, depth, number of pleural passes, and technical success. Pair-wise comparisons of the remaining variables demonstrated a significant younger age and smaller needle size in the biopsy only group, and less minor complications in the fiducial only group. Overall there were 80/285 (28.1%) minor and 29/285 (10.2%) major complications. All major complications leading to admission consisted of either pneumothorax or hemothorax, while minor complications included asymptomatic stable or resolving pneumothoraces, transient hemoptysis or small hemothoraces. Conclusions: A combined procedure of percutaneous pulmonary core biopsy and stereotactic seed placement can be performed without additional risk of a major complication when compared to performing these separately.

  19. Retrospective analysis of technical success rate and procedure-related complications of 867 percutaneous CT-guided needle biopsies of lung lesions.

    Science.gov (United States)

    Mills, M; Choi, J; El-Haddad, G; Sweeney, J; Biebel, B; Robinson, L; Antonia, S; Kumar, A; Kis, B

    2017-08-26

    To investigate the technical success rate and procedure-related complications of computed tomography (CT)-guided needle biopsy of lung lesions and to identify the factors that are correlated with the occurrence of procedure-related complications. This was a single- institution retrospective study of 867 consecutive CT-guided needle biopsies of lung lesions performed on 772 patients in a tertiary cancer centre. The technical success rate and complications were correlated with patient, lung lesion, and procedure-related variables. The technical success rate was 87.2% and the mortality rate was 0.12%. Of the 867 total biopsies 25.7% were associated with pneumothorax, and 6.5% required chest tube drainage. The haemothorax rate was 1.8%. There was positive correlation between the development of pneumothorax and smaller lesion diameter (ptechnical success and a low rate of major complications. The present study has revealed several variables that can be used to identify high-risk procedures. A post-procedural chest X-ray within hours after the procedure is highly recommended to identify high-risk patients who require chest tube placement. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  20. The clinical application of spiral CT guided percutaneous vertebroplasty --76 cases analysis%螺旋CT引导下经皮椎体成形术的临床应用--附76例病例分析

    Institute of Scientific and Technical Information of China (English)

    蔡国荣; 陈学琴; 胡双庆; 张仁军; 李智明

    2014-01-01

    目的:探讨CT引导下经皮椎体成形术的常规手术方法和对不同胸腰椎椎体疾病的临床治疗效果。方法对76例胸、腰椎椎体病变患者进行了经皮穿刺椎体成形术(PVP),CT引导下椎弓根入路穿刺进入椎体行骨髓腔造影并向椎体内加压注射聚甲基丙烯酸甲酯骨水泥。结果椎弓根穿刺成功率100%,骨水泥均匀充填椎体者49例次,27例为部分充填椎体,其中27例成形术后椎体前部高度部分恢复,有70例患者术后疼痛缓解,在注射骨水泥后15 min至3 d起效。结论经皮穿刺椎体成形术这一技术适用于椎体肿瘤和椎体压缩性骨折的治疗,有效而安全,尤其适用于年龄大、机体状况差和不能接受大型手术的高危患者,而在CT引导下解剖关系更精确,定位更准确,操作更安全。%Objective Study on CT-guided percutaneous vertebroplasty for conventional surgical Methods and the different thoracic and lumbar vertebral disease clinical treatment.Methods76 cases of thoracic and lumbar vertebral disease patients with percutaneous vertebroplasty (PVP),CT-guided percutaneous transpedicular approach in angiography of vertebral body marrow cavity and vertebral body to pressure injection of poly methyl methacrylate bone cement.ResultsSuccess rate of pedicle screw spinal puncture is 100%. Uniform iflling vertebral body with bone cement in 49 cases and 27 for iflling vertebral body, of which 27 cases of postoperative vertebral body height in the front part of the recovery, 70 cases of patients with postoperative pain relief, at 15 min after the injection of bone cement to 3d effect.ConclusionPercutaneous vertebroplasty for this technology is suitable for vertebral body compression fracture of vertebral body tumor and treatment, effective and safe, especially in older, poor body condition and not high risk patients undergoing major surgery, in CT-guided anatomy is more precise, more accurate positioning

  1. Analysis of clinical application of percutaneous chest lesion puncture under CT guided%CT引导下经皮胸部病灶穿刺的临床应用分析

    Institute of Scientific and Technical Information of China (English)

    熊丽纹; 滕家俊; 李榕; 张雪艳; 楼煜清; 顾爱琴; 韩宝惠

    2013-01-01

    Background and purpose:Percutaneous transthoracic needle biopsy with computed tomographic (CT) guidance, following two diagnostic methods of needle biopsy and needle aspiration cytology, is a widely used non-vascular interventional technique, regarded as an extremely important technique for clinical qualitative diagnosis, treatment and the prognosis. This study aimed to evaluate and to compare the diagnostic value of needle biopsy and needle aspiration cytology in CT-guided percutaneous chest lesion puncture, and to analyze the variables affecting the diagnostic accuracy and rates of complications. Methods:A retrospective study was conducted of 1 027 patients who underwent CT-guided percutaneous thoracopathy puncture from Apr. 2006 to Mar. 2012. Results:There were no significant differences in diagnostic positive rate and accuracy between needle biopsy and needle aspiration cytology in CT-guided percutaneous chest lesion puncture (P>0.05). There were 859 malignant and 168 benign lesions. Overall diagnostic accuracy was 90.6%. The diagnostic accuracy for malignancy was 89.1%and for benign was 98.2%. There was significant correlation among the diagnostic accuracy and the final diagnosis (benign and malignant), lesion site, and lesion type (P0.05).1027例患者中,恶性病变859例,良性病变168例,诊断正确率为90.6%,其中对恶性肿瘤的诊断正确率为89.1%,良性病变的诊断正确率为98.2%.病灶的良恶性、疾病部位和病灶形态对诊断正确率的影响差异有统计学意义(P<0.05).不良反应(气胸和出血)的发生率为19.9%,与穿刺深度和病灶至胸膜距离密切相关(P<0.05).结论:CT引导下胸部穿刺术是安全、可靠的微创诊断方法.在某些条件下,CT引导下胸部穿刺针吸脱落细胞学检测可以代替活检,以避免那些需要通过增加穿刺风险获取足够组织进行的活检.诊断正确率与病灶的良恶性、发生部位和形态相关.并发症的发生与穿刺深度和

  2. CT引导下射频热凝联合臭氧消融术治疗腰椎间盘突出症%CT-guided radiofrequency thermocoagulation combined with ozone nucleus pulposus ablation in treatment of lumbar disc herniation

    Institute of Scientific and Technical Information of China (English)

    高笛

    2012-01-01

    目的 观察CT引导下射频热凝联合臭氧消融术治疗腰椎间盘突出症(LDH)的临床疗效及安全性.方法 选取80例LDH患者,随机分臭氧组(40例)和联合组(40例),臭氧组给予单纯的臭氧溶核术,联合组先行射频热凝治疗,后行椎间盘内、盘外臭氧溶核术.采用视觉模拟疼痛评分(VAS)作为疼痛水平评价指标,改良Macnab标准评估治疗效果.观察术后1、3、6、12个月VAS评分及术后12个月总有效率.结果 2组术后1、3、6、12个月腰腿痛VAS评分显著低于治疗前(P均<0.01);且联合组VAS评分显著低于臭氧组(P<0.05或P<0.01).术后12个月联合组的总有效率(91.9%)显著高于臭氧组(74.3%),差异有统计学意义(P<0.05).2组患者均无过敏反应、椎间隙感染或脊髓、神经、血管及腹腔脏器损伤等严重并发症.结论 CT引导下靶点射频热凝加臭氧消融术治疗LDH安全、微创,较单纯臭氧消融术疗效更好,恢复更快.%Objective To observe the effects and safety of CT-guided radiofrequency thennocoagulation combined with ozone nucleus pulposus ablation in treatment of lumbar disc hemiation. Methods Eighty cases with lumbar disc hemia-tion were randomly divided into ozone treatment group ( 40 cases ) and combination treatment group ( 40 cases ). The cases in the ozone group were treated with ozone nucleus pulposus ablation therapy alone, another 40 cases in the combination group were treated with ozone nucleus pulposus ablation therapy at once after radiofrequency thermocoagulation. Therapeutic effects were evaluated at the time points of 1 month, 3 months,6 months and 12 months after surgery by using the average scores of VAS and Macnabs standard. Results The average scores of VAS at the time points of 1 month,3 months,6 months and 12 months after surgery in both groups were significantly lower than before treatment ( all P < 0. 01 ), and it was more obviously in the combination treatment group than that in the

  3. CT引导下经皮肺穿刺在肺弥漫性病变中诊断价值%Diagnostic value of CT guided percutaneous lung biopsy in diffuse lung diseases

    Institute of Scientific and Technical Information of China (English)

    宋新宇; 陈世雄; 曾凡军; 高宝安

    2013-01-01

    目的 评价CT引导下经皮肺穿刺在肺弥漫性病变中的诊断价值.方法 应用16 GBARD活检针穿刺32例肺部弥漫性病变患者,主要影像学改变包括弥漫性网格样结节或结节影,网状线形阴影和弥漫性磨玻璃影.结果 32例患者均取材成功,并获得明确诊断,10例恶性肿瘤,(其中5例肺泡癌,5例肺癌肺内转移),22例良性病变(7例粟粒性肺结核,7例间质性肺炎,2例肺泡蛋白沉积征,2例肺真菌病,1例闭塞性支气管炎伴机化性肺炎,1例肺结节病,1例过敏性肺炎,1例弥漫性泛细支气管炎).主要并发症是气胸(22.5%)和出血(21.9%).结论 CT引导下经皮肺穿刺是一种实用、安全、并发症低的技术,对弥漫性肺疾病有很高的确诊率.%Objective To assess the diagnostic value of CT-guided percutaneous lung biopsy in diffuse lung diseases. Methods CT-guided percutaneous lung biopsy was performed in 32 patients with diffuse lung diseases by 16G BARD biopsy needle. The main imaging changes of these patients included network of diffuse nodular or nodular, diffuse reticular lines shadow and diffuse ground-glass density in the lungs. Results Punctures were successful in all 32 patients, and the diseases were clearly diagnosed, which included 10 patients with malignant tumor ( 5 cases of bronchioloalveolar carcinoma and 5 cases of metastatic carcimoma ) and 22 patients with benign tumor ( 7 cases of disseminated pulmonary tuberculosis, 7 cases of interstitial pneumonia, 2 cases of pulmonary alveolar proteinosis, 2 cases of pulmonary mycoses, 1 case of hronchiolitis obliterans with organizing pneumonia, 1 case of sarcoidosis of lung, 1 case of allergic pneumonia and 1 diffuse panbronchiolitis ). The major complications of puncture were pneumothorax ( 22. 5% ) and bleeding ( 21. 9% ). Conclusion CT-guided percutaneous lung biopsy is a useful and safe technique with low complication and high accuracy rate in the diagnosis of patients with diffuse lung

  4. Radiation exposure in CT-guided interventions

    Energy Technology Data Exchange (ETDEWEB)

    Kloeckner, Roman, E-mail: Roman.Kloeckner@unimedizin-mainz.de [Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz (Germany); Santos, Daniel Pinto dos; Schneider, Jens [Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz (Germany); Kara, Levent [Department of Radiology, Inselspital Bern, Freiburgstraße 18, 3010 Bern (Switzerland); Dueber, Christoph; Pitton, Michael B. [Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz (Germany)

    2013-12-01

    Purpose: To investigate radiation exposure in computed tomography (CT)-guided interventions, to establish reference levels for exposure, and to discuss strategies for dose reduction. Materials and methods: We analyzed 1576 consecutive CT-guided procedures in 1284 patients performed over 4.5 years, including drainage placements; biopsies of different organs; radiofrequency and microwave ablations (RFA/MWA) of liver, bone, and lung tumors; pain blockages, and vertebroplasties. Data were analyzed with respect to scanner settings, overall radiation doses, and individual doses of planning CT series, CT intervention, and control CT series. Results: Eighy-five percent of the total radiation dose was applied during the pre- and post-interventional CT series, leaving only 15% applied by the CT-guided intervention itself. Single slice acquisition was associated with lower doses than continuous CT-fluoroscopy (37 mGy cm vs. 153 mGy cm, p < 0.001). The third quartile of radiation doses varied considerably for different interventions. The highest doses were observed in complex interventions like RFA/MWA of the liver, followed by vertebroplasty and RFA/MWA of the lung. Conclusions: This paper suggests preliminary reference levels for various intervention types and discusses strategies for dose reduction. A multicenter registry of radiation exposure including a broader spectrum of scanners and intervention types is needed to develop definitive reference levels.

  5. Related progress of CT-guided percutaneous biopsy in the thoracic complications of acquired immune deficiency syndrome and occupational exposure prevention%CT引导下经皮穿刺活检术在获得性免疫缺陷综合征胸部并发症中的应用及职业暴露防护相关进展

    Institute of Scientific and Technical Information of China (English)

    王青

    2011-01-01

    CT-guided percutaneous biopsy in the thoracic complications of acquired immunodeficiency syndrome (AIDS)is the main clear diagnosis method.The application of technical solutions, complications and prevention, occupational exposure protection principles and methods of CT-guided percutaneous biopsy in thoracic complications of AIDS were reviewed in this article.%CT引导下经皮穿刺活检术是确诊获得性免疫缺陷综合征(AIDS)胸部并发症的主要方法.本文对CT引导下经皮穿刺活检术在AIDS胸部并发症中应用的技术方案、并发症及预防,职业暴露防护原则及方法进行综述.

  6. CT引导经皮肺切割活检术诊断活动性韦格纳肉芽肿%Percutaneous CT -guided Core Needle Biopsy of Lungs in the Diagnosis of Active Wegener's Granulomatosis

    Institute of Scientific and Technical Information of China (English)

    陈敏; 郭佑民; 张少娟; 杨健; 牛刚; 汪军峰

    2005-01-01

    目的探讨CT引导下经皮肺芯针切割活检术(percutaneous CT-guided core needle biopsy,PTCB)对活动性韦格纳肉芽肿(WG)的诊断价值以及指导临床治疗的意义.方法8例经PTCB行病理组织学检查WG病人,根据其临床资料作BVAS评分,其结果与病理对照研究.结果8例病人经PTCB取得足够的组织学标本,病理结果:①坏死性血管炎(75%),②肉芽性炎症(62.5%),③实质坏死(50%),④肺出血改变(12.5%),⑤纤维化(12.5%).确诊时BVAS平均分数为10分,所有病人确诊后都进行了糖皮质激素联合细胞毒药物冲击治疗,临床有不同程度好转,治疗4周后平均分数为2.5分.结论多部位、多次经皮肺切割活检可以准确的诊断活动性WG,指导临床早期治疗.

  7. Percutaneous lumbar sympathectomy: A comparison of radiofrequency denervation versus phenol neurolysis

    Energy Technology Data Exchange (ETDEWEB)

    Haynsworth, R.F. Jr.; Noe, C.E. (Baylor Univ. Medical Center, Dallas, TX (USA))

    1991-03-01

    A new percutaneous approach to sympathectomy using radiofrequency denervation has seemed to offer longer duration and less incidence of postsympathetic neuralgia as compared to phenol sympathetic blocks. To compare these techniques, 17 patients underwent either phenol lumbar sympathetic blocks (n = 9) or radiofrequency denervation (n = 8). Duration of sympathetic block was followed by a sweat test and temperature measurements. Results indicate that 89% of patients in the phenol group showed signs of sympathetic blockade after 8 weeks, as compared to 12% in the radiofrequency group (P less than 0.05). Although the incidence of post sympathetic neuralgia appears to be less with radiofrequency denervation, further refinement of needle placement to ensure complete lesioning of the sympathetic chain will be required before the technique can offer advantages over current phenol techniques.

  8. CT引导经皮置钉治疗病理性骶髂关节疼痛%Percutaneous CT-guided fixation of sacroiliac joint with cannulated lag screw for treating pathologic pain of sacroiliac joint

    Institute of Scientific and Technical Information of China (English)

    胡勇; Ebraheim NA; 徐荣明; 薛波

    2005-01-01

    BACKGROUND: Most patients with posterior pelvic and sacroiliac metastasis are terminally ill. Their treatment is usually palliative and directed toward relieving pain and improving the quality of life with the least possible intervention.OBJECTIVE: To investigate the possibility of percutaneous CT-guided fixation of sacroiliac joint with cannulated lag screw treatment for pathologic pain of sacroiliac joint.DESIGN: Preoperative and postoperative auto-control clinical trial was conducted.SETTING and PARTICIPANTS: The study was completed in Ningbo Sixth Hospital. Eight patients(4 males and 4 females, aged 12 years to 83 years)with metastatic tumor of sacroiliac joint were selected for our study.METHODS: After treatment with percutaneous CT-guided fixation of sacroiliac joint with cannulated lag screw, the sacroiliac joint of the 8 patients became pathologically unstable. Enneking pain scale was obtained preoperatively and postoperatively.MAIN OUTCOME MEASURES: Pain recovery was assessed preoperatively and postoperatively.RESULTS: After 2. 5 years' follow-up, pain of the patients was relieved with a range of 0 to 5(mean 3.2).CONCLUSION: Percutaneous cannulated lag screws with CT guidance help alleviate the patients' pain due to pathologically unstable sacroiliac joint.%背景:大多数后路骨盆和骶髂关节转移肿瘤患者为临终患者,其治疗目的主要是姑息治疗和减轻疼痛,提高患者生活质量.目的:探讨在CT引导下经皮微创技术置入空心拉力螺钉治疗病理性骶髂关节疼痛.设计:前后对照的临床试验.地点和对象:在浙江省宁波市第六医院完成.8例骶髂关节转移肿瘤患者,男4例,女4例;年龄12~83岁.方法:对8例骶髂关节转移肿瘤患者试行在CT引导下经皮微创技术置入空心拉力螺钉稳定病理性骶髂关节不稳.术前和术后进行Enneking疼痛评分.主要观察指标:手术前后疼痛恢复情况.结果:经2年5个月随访,患者疼痛减轻,平均3.2

  9. Effect of percutaneous renal sympathetic nerve radiofrequency ablation in patients with severe heart failure.

    Science.gov (United States)

    Dai, Qiming; Lu, Jing; Wang, Benwen; Ma, Genshan

    2015-01-01

    This study aimed to investigate the clinical feasibility and effects of percutaneous renal sympathetic nerve radiofrequency ablation in patients with heart failure. A total of 20 patients with heart failure were enrolled, aged from 47 to 75 years (63±10 years). They were divided into the standard therapy (n = 10), and renal nerve radiofrequency ablation groups (n = 10). There were 15 males and 5 female patients, including 8 ischemic cardiomyopathy, 8 dilated cardiomyopathy, and 8 hypertensive cardiopathy. All of the patients met the criteria of New York Heart Association classes III-IV cardiac function. Patients with diabetes and renal failure were excluded. Percutaneous renal sympathetic nerve radiofrequency ablation was performed on the renal artery wall under X-ray guidance. Serum electrolytes, neurohormones, and 24 h urine volume were recorded 24 h before and after the operation. Echocardiograms were performed to obtain left ventricular ejection fraction at baseline and 6 months. Heart rate, blood pressure, symptoms of dyspnea and edema were also monitored. After renal nerve ablation, 24 h urine volume was increased, while neurohormone levels were decreased compared with those of pre-operation and standard therapy. No obvious change in heart rate or blood pressure was recorded. Symptoms of heart failure were improved in patients after the operation. No complications were recorded in the study. Percutaneous renal sympathetic nerve radiofrequency ablation may be a feasible, safe, and effective treatment for the patients with severe congestive heart failure.

  10. Percutaneous radiofrequency rhizotomy of lumbar spinal facets: the results of 46 cases.

    Science.gov (United States)

    Göçer, A I; Cetinalp, E; Tuna, M; Ildan, F; Bağdatoğlu, H; Haciyakupoğlu, S

    1997-01-01

    The results of percutaneous radiofrequency rhizotomy of lumbar spinal facets in 46 patients followed at least three months (mean 15 months) are reported and compared with those reported previously. Satisfactory pain relief three months after the procedure was achieved in 36.4 percent of patients without operations and in 41.7 percent of patients, with operations other than fusion. No patient had previously undergone fusion. Treatment of low-back pain by using radio-frequency thermocoagulation of spinal facets is a simple, safe, and well-tolerated procedure. It can be used to relief of pain in spite of decreasing rates of success within the follow-up period.

  11. Radiofrequency thermal ablation (RFA) of liver tumors: open surgical or percutaneous approach?

    Science.gov (United States)

    Crucitti, A; Danza, F M; Pirulli, P G V; Antinori, A; Antonacci, V; La Greca, A; Bock, E; Magistrelli, P

    2004-11-01

    RFA was used to ablate 81 liver lesions: 61 liver metastases and 20 hepatomas. An open surgical approach was adopted in 19 instances (27.5%), 12 of which were simultaneously treated for associated diseases, and percutaneous treatment was adopted in 50 instances (72.5%). The CT liver control at 6 months showed a complete necrosis in 50 lesions (66.3%). The advantages of the percutaneous approach include less invasiveness, reduced postoperative pain, shorter hospitalization, reduced costs and less discomfort in repeating the procedure. In conclusion, radiofrequency liver nodule ablation could be considered, today, as one of the promising and versatile techniques for loco-regional liver cancer control.

  12. Diagnostic Value of MSCT in Osteoid Osteoma and the results of CT-guided percutaneous removal of Osteoid Osteoma%骨样骨瘤的MSCT诊断与CT引导下切除的疗效分析

    Institute of Scientific and Technical Information of China (English)

    郑芸; 杨贤卫; 冷晓明; 朱丹; 许焕奇

    2011-01-01

    目的 分析骨样骨瘤的CT表现并探讨其诊断及治疗价值.方法 回顾性分析12例经手术病理证实的骨样骨瘤,12例均行普通X线及CT检查,其中3例同时行MRI检查,分析比较X线、CT和MRI对瘤巢及瘤巢周围骨质改变的显示能力.结果 瘤巢均表现为圆形或卵圆形透亮区,直径小于20mm,8例中心可见钙化,呈牛眼征.4例呈环征.瘤巢周围可有不同程度的骨质硬化、骨膜反应、骨髓水肿、软组织肿胀及相邻关节腔积液.CT术前诊断正确11例(91.7%),普通X线术前诊断正确7例 (58.3%),3例MRI检查中1例增强扫描术前诊断正确,2例平扫只提示诊断.7 例行CT导引下瘤巢毁损,5例CT引导定位后手术治疗,追访6个月-3年未见疼痛复发及明显并发症.结论 瘤巢是骨样骨瘤的特征性表现,CT对瘤巢显示最准确,MRI则对显示瘤巢周围骨髓、软组织及关节腔情况敏感.CT引导下经皮穿刺切除骨样骨瘤是一种简单有效、安全可靠的微创性治疗方法.%Objective To analysis the appearances and to evaluate the diagnostic value of CT imaging in osteoid osteoma.Methods 12 cases of osteoid osteoma proved by surgical pathology and their X-ray,CT and MR1 were re-viewed.All atients had X-ray and CT scanning,3with MR imaging.The ability of X-ray,CT and MRI to demonstrate the nidus and surrounding reaction were analyzed.Results The nidus were appeared as round or oval shape and the diameter was less than 20mm.8 nidus manifested as "ancox eye" sign of calcification in focuscenter.4 nidus manifested as an ringsign without calcification in focuscenter.There were different degree of bone sclerosis,periosteal reaction and soft tissues or bone marrow edema around the nidus.The diagnostic accuracy was 58.3% for X-ray,91.7% for CT.Accurate diagnosis was obtained before surgery in lease of MR1,the other 2 cases were only suggestive of the diagnosis.CT-guided percutaneous excision had undergone in twelve patients

  13. Selective percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia:report on 1860 cases

    Institute of Scientific and Technical Information of China (English)

    吴承远; 孟凡刚; 徐淑军; 刘玉光; 王宏伟

    2004-01-01

    @@Trigeminal neuralgia (TN) is defined by the International Association for the Study of Pain as "a sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve".1 The incidence rate is about three to five cases per year per 100000 persons and increases with age.2 In our hospital, percutaneous radiofrequency therapy was performed on 1860 patients with TN from June 1986 to April 2003, and percutaneous trigeminal ganglion radiofrequency therapy on 579 cases. Among this group of patients, X-ray, 3-D CT, and navigational localization of the oval foramen were performed on 42 cases. The indications, techniques, and results are reported here.

  14. The clinical applications of CT-guided percutaneous microwave ablation of hip osteoid osteoma%CT引导下经皮穿刺微波热消融术治疗髋部骨样骨瘤

    Institute of Scientific and Technical Information of China (English)

    纪经涛; 胡永成; 夏群; 王林森

    2010-01-01

    目的 探讨CT引导下经皮穿刺微波热消融术治疗髋部骨样骨瘤的可行性.方法 2006年8月至2010年1月对8例髋部骨样骨瘤患者采用CT引导下经皮穿刺微波热消融治疗,男5例,女3例;年龄12~25岁,平均18.8岁.患者均有髋部疼痛症状,夜间加剧.病史2个月至10年.病变部位:股骨颈4例、股骨小转子2例、股骨大转子1例,股骨转子间1例.术中应用CT薄层横断扫描确定病灶部位,将骨穿刺针经皮穿入瘤巢中心.行CT扫描证实穿刺针位置准确后撤出针芯,用穿刺针套管刮除瘤壁及瘤巢内肿瘤组织送病理学检查.再将微波探针沿骨穿刺针穿入瘤巢中心,将瘤巢中心温度逐渐加热至90℃,保持4~6min.术后预防性应用抗生素2 d.结果 3例病理学检查诊断为骨样骨瘤,另5例仅获得诊断性描述.全部病例随访6~21个月.术后24 h内疼痛均有不同程度缓解,1例随访5个月时仍有轻度夜间隐痛,再次行微波热消融治疗,随访8个月无复发.所有患者均未见股骨头坏死及其他并发症.结论 CT引导下骨样骨瘤经皮穿刺微波热消融术可以有效缓解或消除髋部疼痛症状,术后并发症少,短期疗效好,是一种安全、有效的新方法.%Objective To evaluate the clinical effectiveness of the treatment for hip osteoid osteoma by CT-guided percutaneous microwave ablation. Methods From August 2006 to January 2010, 8 patients with the osteoid osteomas of the hip were treated with CT-guided percutaneous microwave ablation, including 5 males and 3 females with an average age of 18.8 years (range, 12 to 25). The history of local pain was ranging from 2 months to 10 years, with aggravation of pain at night. The locations of the lesions contained: 4cases in the neck of femur, 2 in the lesser trochanter, 1 in the greater trochanter and 1 in the femoral intertrochanteric line. After localization of the nidus with CT, osseous access was established with a Gallini puncturatio

  15. Subclinical Breast Cancer: Minimally Invasive Approaches. Our Experience with Percutaneous Radiofrequency Ablation vs. Cryotherapy

    Science.gov (United States)

    Manenti, Guglielmo; Scarano, Angela L.; Pistolese, Chiara A.; Perretta, Tommaso; Bonanno, Elena; Orlandi, Augusto; Simonetti, Giovanni

    2013-01-01

    Summary Background The aim of this study was to compare the efficacy of radiofrequency ablation vs. cryoablation in the treatment of early breast cancer. Patients and Methods 80 women (mean age 73 ± 5 years) with early breast cancer were retrospectively evaluated. 40 patients underwent cryoablation and 40 patients underwent radiofrequency ablation, both with sentinel lymph node excision. Tumor volume and histopatological data were compared by means of postprocedural 3.0-T magnetic resonance imaging (MRI). 30–45 days after the percutaneous ablation, all patients underwent surgical resection of the tumor. The mean follow-up was 18 months without any local recurrences. Results Both techniques allow good correlation with histopathological data. In 75 patients (93.8%) we observed complete necrosis; in 5 cases there was residual disease in the postprocedural MRI and postoperative histological examination. There was a good correlation between MRI volume and histologic samples. Cosmetic results were good in all patients but 2. Conclusion Both percutaneous radiofrequency ablation and cryotherapy are minimally invasive techniques with a good clinical and cosmetic outcome in selected cases. MRI examination is an ideal method to assess breast neoplasms in terms of quality and quantity as well as residual tumor extent after percutaneous ablation. Cryotherapy is the preferred method because of the analgesic effect of freezing with better patients compliance. PMID:24415989

  16. CT引导下选择性穿刺圆孔射频热凝术在上颌神经痛治疗中的应用%Application of CT-Guided Selective Foramen Rotundum Puncture Radiofrequency Thermocoagulation in the Treatment of Maxillary Neuralgia

    Institute of Scientific and Technical Information of China (English)

    赵传军; 王烈伟

    2014-01-01

    Objective To evaluate the application value of CT-guided selective foramen rotundum puncture radiofrequency thermocoagulation in the treatment of maxillary neuralgia. Methods CT-guided puncture of 18 patients with maxillary neuralgia was conducted and then the veriifcation of the puncture positions was also conducted. Based on the correct puncture positions, radiofrequency thermocoagulation of maxillary nerve within the target region was conducted. Results After radiofrequency thermocoagulation, the pain condition of 12 patients was completely mitigated and that of 4 patients was partial mitigated while that of 2 patients was unchanged, which showed that the total effective rate of radiofrequency thermocoagulation was 88.8﹪. The results of 6 months follow-up showed that the relapse of maxillary neuralgia occurred in 4 patients. Conclusion CT-guided selective foramen rotundum puncture radiofrequency thermocoagulation with accurate positioning, favourable curative effect and simple operation methods is suitable for the treatment of maxillary neuralgia.%目的:探讨CT引导下选择性穿刺圆孔射频热凝术在上颌神经痛治疗中的应用价值。方法在CT引导下,对18例上颌神经痛患者进行穿刺并对穿刺位置进行验证;确保穿刺位置无误后,对靶区域的上颌神经进行射频热凝毁损。结果术后疼痛完全消失12例,减轻4例,无缓解2例,总有效率88.8%;经6个月随访,4例复发。结论CT引导下选择性穿刺圆孔射频热凝术治疗定位准确、疗效好、操作简单,适用于上颌神经痛的治疗。

  17. CT引导下经皮肺活检在弥漫性实质性肺疾病的临床应用%The diagnostic value of CT-guided percutaneous needle lung biopsy in diffuse parenchymal lung diseases

    Institute of Scientific and Technical Information of China (English)

    彭敏; 冯瑞娥; 刘鸿瑞; 朱元珏; 许文兵; 施举红; 蔡柏蔷; 田欣伦; 柳涛; 张弘; 肖教; 刘巍

    2012-01-01

    目的 探讨CT引导下经皮切割针肺活检在影像学表现为弥漫性实质性肺疾病诊断中的作用和应用范围.方法 选择2000年1月至2008年12月北京协和医院行CT引导下经皮肺活检、胸部CT表现为双肺弥漫病变且临床资料完整的弥漫性实质性肺疾病患者248例.排除胸部CT为单发病变及单肺病变的病例.回顾分析所有病例的病史、血免疫学、支气管镜、胸部高分辨CT及肺活检病理等检查结果.结果 男114例,女134例,年龄13~78岁,平均年龄(50±16)岁.248例中经皮肺活检获得病理形态学诊断130例(52.4%),确诊疾病分别为肺部感染性疾病46例(35.4%),肺部肿瘤33例(25.4%),闭塞型细支气管炎伴机化性肺炎/机化性肺炎(BOOP/OP) 29例(22.3%),血管炎8例(6.2%),肉芽肿病变6例(4.6%),结节病3例(2.3%),弥漫性肺泡损伤和肺淀粉样变各2例(1.5%),以及肺泡蛋白沉积症(PAP)1例(0.7%).经皮肺活检未确定诊断的118例患者中有37例进行了开胸或胸腔镜肺活检,36例确定诊断,分别为非特异性间质性肺炎(NSIP) 12例,寻常型间质性肺炎(UIP)3例,感染6例,肿瘤3例,淋巴细胞间质性肺炎(LIp)、肺血管炎和过敏性肺炎(HP)各2例,结节病、ABPA、肺透明样肉芽肿病、肺尘埃沉积症、Castleman病及淋巴增殖性疾病各1例.经皮肺活检未确定诊断的118例患者中有69例结合临床及其他检查获得诊断.结论 约半数弥漫性实质性肺疾病患者通过CT引导下经皮肺活检能够获得特定的病理形态学诊断,尤其是影像学表现为双肺弥漫病变的感染及肿瘤病例确诊阳性率较高,但对于特发性间质性肺炎诊断价值有限,应结合患者的临床实际情况选择应用.%Objective This study was to evaluate the efficacy and limitation of CT-guided percutaneous cutting needle lung biopsy in the diagnosis of diffuse parenchymal lung diseases (DPLD).Methods A total of 481 patients admitted

  18. Flat-Panel Cone-Beam Ct-Guided Radiofrequency Ablation of Very Small (≤1.5 cm) Liver Tumors: Technical Note on a Preliminary Experience

    Energy Technology Data Exchange (ETDEWEB)

    Cazzato, Roberto Luigi, E-mail: r.cazzato@unicampus.it; Buy, Xavier, E-mail: x.buy@bordeaux.unicancer.fr; Alberti, Nicolas, E-mail: nicoalbertibdx@gmail.com; Fonck, Mariane, E-mail: m.fonk@bordeaux.unicancer.fr [Institut Bergonié 229 Cours de l’Argonne, Department of Radiology (France); Grasso, Rosario Francesco, E-mail: r.grasso@unicampus.it [Università “Campus Bio-Medico di Roma”, Department of Radiology and Diagnostic Imaging (Italy); Palussière, Jean, E-mail: j.palussiere@bordeaux.unicancer.fr [Institut Bergonié 229 Cours de l’Argonne, Department of Radiology (France)

    2015-02-15

    PurposeThe aim of the present study was to investigate the technical feasibility of flat-panel cone-beam CT (CBCT)-guided radiofrequency ablation (RFA) of very small (<1.5 cm) liver tumors.Materials and MethodsPatients included were candidates for hepatic percutaneous RFA as they had single biopsy-proven hepatic tumors sized ≤1.5 cm and poorly defined on ultrasonography. Following apnea induction, unenhanced CBCT scans were acquired and used to deploy the RF electrode with the aid of a virtual navigation system. If the tumor was not clearly identified on the unenhanced CBCT scan, a right retrograde arterial femoral access was established to carry out hepatic angiography and localize the tumor. Patients’ lesions and procedural variables were recorded and analyzed.ResultsThree patients (2 male and 1 female), aged 68, 76, and 87 years were included; 3 lesions (2 hepato-cellular carcinoma and 1 metastasis from colorectal cancer) were treated. One patient required hepatic angiography. Cycles of apnea used to acquire CBCT images and to deploy the electrode lasted <120 s. Mean fluoroscopic time needed to deploy the electrode was 36.6 ± 5.7 min. Mean overall procedural time was 66.0 ± 22.9 min. No peri- or post-procedural complications were noted. No cases of incomplete ablation were noted at 1-month follow-up.ConclusionPercutaneous CBCT-guided liver RFA with or without arterial hepatic angiography is technically feasible.

  19. CT引导下经皮穿刺氩氦刀冷冻消融术治疗肾癌的临床应用研究%Clinical application of CT-guided percutaneous cryoablation for renal neoplasms

    Institute of Scientific and Technical Information of China (English)

    任超; 肖越勇; 吴斌; 张肖; 刘士榕; 马旭阳

    2012-01-01

    目的 探讨CT引导监测,经皮穿刺氩氦刀冷冻消融术治疗肾癌的技术方法、安全性及临床疗效.方法 选取2008年9月至2011年1月于我院就诊的肾肿瘤患者27例,采用CT引导氩氦刀冷冻消融疗法,对治疗后局部靶病灶变化、术后肾功能变化、中位生存时间及生存率进行动态随访观察,并记录并发症情况.结果 本组27例患者,术后即刻CT扫描显示冰球覆盖率均为100%.术后3个月复查CT示靶病灶密度减低,瘤体不同程度缩小,按实体瘤评价标准,其中完全缓解(CR)23例,部分缓解(PR)2例,病灶稳定(SD)2例,缓解率(CR+PR)为92.6%.术后第3~4天复查肾功能(尿素氮、尿酸和肌酐等),与术前相比均未见明显变化.本组术后无严重并发症(包括皮肤冻伤、感染、穿刺种植转移等)发生,6例子术后1d出现发热(38℃左右),对症治疗后3~5d消退,8例出现局部轻度疼痛,服用止痛药后缓解;2例出现术后出血,应用凝血酶后迅速止血.结论CT引导监测,经皮穿刺氩氦刀冷冻消融术治疗肾肿瘤近期疗效肯定,是一种安全可靠、值得推广的微创治疗方法.%Objective To investigate the safety,efficacy and clinical value of CT-guided cryoablation for renal cellular carcinoma (RCC). Methods 27 patients with RCC were treated with CT-guided cryoablation from August 2008 to January 2011, CT scan were performed to monitor the dynamic changes at different stages after the cryosurgery. The treatment response and survival rate were tested to evaluated the efficacy of the surgery. Results All the patients underwent percutaneous conformal cryoablation, the immediate CT scan after cryosurgery showed the lesions of all the patients were completely covered by iceball. CT scan performed at 1 month,3 month,6 month and 1 year after the procedure, the lesions were showed abviousiy decrease on density, the tumor size decreased,and there was no enhancement. According to the CT scans,23

  20. Percutaneous Radiofrequency Ablation of Painful Osseous Metastases: A Multi-center American College of Radiology Imaging Network Trial

    Science.gov (United States)

    Dupuy, Damian E.; Liu, Dawei; Hartfeil, Donna; Hanna, Lucy; Blume, Jeffrey D.; Ahrar, Kamran; Lopez, Robert; Safran, Howard; DiPetrillo, Thomas

    2009-01-01

    Background To determine if radiofrequency ablation (RFA) can safely reduce pain from osseous metastatic disease. Methods A single arm prospective trial in patients with a single painful bone metastasis with unremitting pain of at least a score above 50 on a pain scale of 0–100. Percutaneous CT guided RFA of the bone metastasis to temperatures above 60 degrees Celsius was performed. Endpoints were the toxicity and pain effects of RFA before and at 2 weeks, one and three months after RFA. Results 55 patients completed RFA. Grade 3 toxicities occurred in 3 of 55 patients (5%). RFA reduced pain at 1- and 3-month for all pain assessment measures. The average increase in pain relief from pre-RFA to 1-month follow-up is 26.27 (95% CI, 17.65 to 34.89, P<0.0001) and the increase from pre-RFA to 3-month follow-up is 16.38 (95% CI, 3.37 to 29.39, P=0.02). The average decrease in pain intensity from pre-RFA to 1-month follow-up was 26.9 (P<0.0001) and 14.2 for 3-month follow-up (P=0.02). The odds of being in lower pain severity at 1-month follow-up is 14.03 (95% CI, 2.33 to 25.73, P<0.0001) times higher than that at pre-RFA, and the odds at 3-month follow-up is 8.00 (95% CI, 0.85 to 15.15, P<0.001) times higher than that at pre-RFA. The average increase in mood from pre-RFA to 1-month follow-up was 19.9 (P<0.0001) and 14.9 for 3-month follow-up (P=0.005). Conclusion This cooperative group trial strongly suggests that RFA can safely palliate pain from bone metastases. PMID:20041484

  1. Percutaneous osteoid osteoma treatment with combination of radiofrequency and alcohol ablation

    Energy Technology Data Exchange (ETDEWEB)

    Akhlaghpoor, S. [Noor Medical Imaging Center, Tehran (Iran, Islamic Republic of)]. E-mail: akhlaghpoor@nmri-ir.com; Tomasian, A. [Noor Medical Imaging Center, Tehran (Iran, Islamic Republic of); Arjmand Shabestari, A. [Noor Medical Imaging Center, Tehran (Iran, Islamic Republic of); Ebrahimi, M. [Noor Medical Imaging Center, Tehran (Iran, Islamic Republic of); Alinaghizadeh, M.R. [Noor Medical Imaging Center, Tehran (Iran, Islamic Republic of)

    2007-03-15

    Aim: To assess the efficacy of percutaneous osteoid osteoma treatment using a combination of radiofrequency ablation (RFA) and alcohol ablation with regard to technical and long-term clinical success. Materials and methods: From December 2001 to November 2004, RFA and subsequent alcohol ablation was performed on 54 patients with osteoid osteoma, diagnosed clinically using radiography, computed tomography (CT) and symptoms. Under general anaesthesia, treatment was performed via percutaneous access under thin section (2 mm) spiral CT guidance in all cases with an 11 G radiofrequency-compatible coaxial needle and 2 mm coaxial drill system and 1.0 cm active tip 17 G non-cooled radiofrequency needle. RFA was performed at 90 {sup o}C for a period of 6 min. After needle removal, 0.5-1.0 ml absolute alcohol (99.8% concentration) was injected directly into the nidus using a 20 G needle. Patients were discharged within 24 h and followed up clinically (at 1 week, 1 month and every 3 months thereafter). Results: The technical success rate was 100%. Complications occurred in two patients consisting of local mild cellulitis in entry site and peripheral small zone paresthesia on the anterior part of leg. The follow-up period range was 13-48 months (mean {+-} SD, 28.2 {+-} 7.4 months). Prompt pain relief and return to normal activities were observed in 52 of 54 patients. Recurrent pain occurred in two patients after a 1 and 3 months period of being pain free, respectively; a second RFA and alcohol ablation was performed achieving successful results. Primary and secondary clinical success rates were 96.3% (52/54 patients) and 100% (2/2 patients), respectively. Conclusion: Percutaneous osteoid osteoma treatment with combination of radiofrequency and alcohol ablation is safe, effective and minimally invasive with high primary and secondary success rates. Persistent or recurrent lesions can be effectively re-treated.

  2. Minimally invasive CT guided treatment of intraspinal synovial cyst.

    Science.gov (United States)

    Kozar, Sergeja; Jeromel, Miran

    2014-03-01

    Intraspinal synovial cysts of vertebral facet joints are uncommon cause of radicular pain as well as neurological deficits. They can be managed both conservatively and surgically. A 77-year old polymorbid patient presented with bilateral low back pain which worsened during the course of time and did not respond to the conservative treatment. A diagnosis of intraspinal synovial cyst was made using the magnetic resonance imaging (MRI). Percutaneous computed tomography (CT) guided injection with installation of local anesthetic together with corticosteroid and rupture of the cyst was successfully used. A month after the procedure his pain improved, the usage of analgesics diminished and his over-all quality of life improved. Percutaneous CT guided lumbar synovial cyst treatment is safe and reliable alternative to the surgical treatment in polymorbid patients with radiculopathy who are not able to tolerate general anesthesia and operation.

  3. Percutaneous Intraductal Radiofrequency Ablation is a Safe Treatment for Malignant Biliary Obstruction: Feasibility and Early Results

    Energy Technology Data Exchange (ETDEWEB)

    Mizandari, Malkhaz [Tbilisi State Medical University, Department of Radiology (Georgia); Pai, Madhava, E-mail: madhava.pai@imperial.ac.uk; Xi Feng [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom); Valek, Vlastimil; Tomas, Andrasina [University Hospital Brno Bohunice, Department of Radiology (Czech Republic); Quaretti, Pietro [IRCCS Policlinico San Matteo, Department of Radiology (Italy); Golfieri, Rita; Mosconi, Cristina [University of Bologna, Department of Radiology, Policlinico S. Orsola-Malpighi (Italy); Ao Guokun [The 309 Hospital of Chinese PLA, Department of Radiology (China); Kyriakides, Charis [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom); Dickinson, Robert [Imperial College London, Department of Bioengineering (United Kingdom); Nicholls, Joanna; Habib, Nagy, E-mail: nagy.habib@imperial.ac.uk [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom)

    2013-06-15

    Purpose. Previous clinical studies have shown the safety and efficacy of this novel radiofrequency ablation catheter when used for endoscopic palliative procedures. We report a retrospective study with the results of first in man percutaneous intraductal radiofrequency ablation in patients with malignant biliary obstruction. Methods. Thirty-nine patients with inoperable malignant biliary obstruction were included. These patients underwent intraductal biliary radiofrequency ablation of their malignant biliary strictures following external biliary decompression with an internal-external biliary drainage. Following ablation, they had a metal stent inserted. Results. Following this intervention, there were no 30-day mortality, hemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the 39 patients, 28 are alive and 10 patients are dead with a median survival of 89.5 (range 14-260) days and median stent patency of 84.5 (range 14-260) days. One patient was lost to follow-up. All but one patient had their stent patent at the time of last follow-up or death. One patient with stent blockage at 42 days postprocedure underwent percutaneous transhepatic drain insertion and restenting. Among the patients who are alive (n = 28) the median stent patency was 92 (range 14-260) days, whereas the patients who died (n = 10) had a median stent patency of 62.5 (range 38-210) days. Conclusions. In this group of patients, it appears that this new approach is feasible and safe. Efficacy remains to be proven in future, randomized, prospective studies.

  4. Percutaneous radio-frequency thermocoagulation of the Gasserian ganglion guided by high-speed real-time CT fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Koizuka, Shiro [Gunma University Graduate School of Medicine, Department of Anesthesiology, Maebashi (Japan); Gunma University Hospital, Department of Anesthesiology, Maebashi (Japan); Saito, Shigeru; Sekimoto, Kenichi; Tobe, Masaru; Obata, Hideaki [Gunma University Graduate School of Medicine, Department of Anesthesiology, Maebashi (Japan); Koyama, Yoshinori [Gunma University Graduate School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Maebashi (Japan)

    2009-09-15

    Although Gasserian ganglion block is an established treatment for trigeminal neuralgia, the foramen ovale cannot always be clearly visualized by classical X-ray radiography. We present a new method for percutaneous radio-frequency thermocoagulation of the Gasserian ganglion, in which computed tomography (CT) fluoroscopy is used to guide needle placement. In the present study, 15 patients with trigeminal neuralgia underwent percutaneous radio-frequency thermocoagulation of the Gasserian ganglion guided by high-speed real-time CT fluoroscopy. Trigeminal neuralgia was improved in all patients after treatment without any severe complications. Moderate dysesthesia occurred in only one case. CT fluoroscopy-guided percutaneous radio-frequency thermocoagulation of the Gasserian ganglion was safe, quick, and effective for patients with intractable idiopathic trigeminal neuralgia. (orig.)

  5. A case of gouty arthritis following percutaneous radiofrequency ablation for hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Dae; Hee; Choi; Hyo-Suk; Lee

    2010-01-01

    Percutaneous radiofrequency thermal ablation(RFA) is considered an effective technique for providing local control in the majority of Hepatocellular carcinoma(HCC) patients.Although RFA is generally well tolerated,recent studies have reported complications associated with RFA.We describe a case of acute gouty arthritis in a 71-year-old man with chronic renal failure who was treated with RFA for a HCC lesion and who had hepatitis B-associated cirrhosis and mild renal insufficiency.Regular surveillance of the...

  6. Ultrasonography guided percutaneous radiofrequency ablation for hepatic cavernous hemangioma

    Institute of Scientific and Technical Information of China (English)

    Yan Cui; Hong-Wen Zhang; Li-Yan Zhou; Man-Ku Dong; Ping Wang; Min Ji; Xiao-Ou Li; Chang-Wei Chen; Zi-Pei Liu; Yong-Jie Xu

    2003-01-01

    AIM: Hepatic cavernous hemangioma (HCH) is the mostcommon benign tumor of the liver and its management isstill controversial. Recent successin situ radiofrequencyablation of hepatic malignancies has led us to consider usingthis technique in patients with HCH. This study was to assessthe efficacy, safety, and complications of percutaneousradiofrequency ablation (PRFA) under ultrasonographyguidance in patients with HCH.METHODS: Twelve patients (four men and eight women,age ranged 33-56 years, mean age was 41.7 years) with 15hepatic cavernous hemangiomas (2.5 cm to 9.5 cm) weretreated using the RF-2000 generator and 10-needle LeVeenelectrode percutaneously guided by B-ultrasound. Lesionslarger than 3 cm were treated by multiple overlappingablations that encompass the entire lesion as well as a rimof normal liver tissue (approximately 0.5 cm).RESULTS: All the patients who received PRFA therapy hadno severe pain, bleeding or bile leakage during and afterthe procedures. Nine to 34 months′ follow-up (mean, 21months) by ultrasound and/or spiral CT scan demonstratedthat the ablated lesions in this group were shrunk remarkably,and the shrunken range was 38-79 % (mean, 67 % per 21months). The contrast enhancement was disappeared withinthe tumor or at its periphery in all cases on spiral CT scansobtained 3 to 6 months after treatment.CONCLUSION: The results of this study suggest that PRFAtherapy is a mini-invasive, simple, safe, and effective methodfor the treatment of selected patients with HCH.

  7. A case of biliary gastric fistula following percutaneous radiofrequency thermal ablation of hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Angela Falco; Dante Orlando; Roberto Sciarra; Luciano Sergiacomo

    2007-01-01

    Percutaneous radiofrequency thermal ablation (RFA) is an effective and safe therapeutic modality in the management of liver malignancies, performed with ultrasound guidance. Potential complications of RFA include liver abscess, ascites, pleural effusion, skin burn,hypoxemia, pneumothorax, subcapsular hematoma,hemoperitoneum, liver failure, tumour seeding, biliary lesions. Here we describe for the first time a case of biliary gastric fistula occurred in a 66-year old man with a Child's class A alcoholic liver cirrhosis as a complication of RFA of a large hepatocellular carcinoma lesion in the Ⅲ segment. Tn the light of this case, RFA with injection of saline between the liver and adjacent gastrointestinal tract, as well as laparoscopic RFA, ethanol injection (PET),or other techniques such as chemoembolization, appear to be more indicated than percutaneous RFA for large lesions close to the gastrointestinal tract.

  8. Needle track seeding: a real hazard after percutaneous radiofrequency ablation for colorectal liver metastasis

    Institute of Scientific and Technical Information of China (English)

    Shirley Yuk-Wah Liu; Kit-Fai Lee; Paul Bo-San Lai

    2009-01-01

    Neoplastic needle track seeding following percutaneous radiofrequency ablation (RFA) of secondary liver tumors is exceedingly rare. Reports on cutaneous tumor seeding after percutaneous RFA for colorectal liver metastasis are even rarer in the literature. Here we report a case of a 46-year-old female who developed an ulcerating skin lesion along the needle track of a previous percutaneous RFA site around 6 mo after the procedure. The previous RFA was performed by the LeVeenR needle for a secondary liver tumor from a primary rectal cancer. The diagnosis of secondary skin metastasis was confirmed by fine needle aspiration cytology. The lesion was successfully treated with wide local excision. We believe that tumor seeding after percutaneous RFA in our patient was possibly related to its unfavorable subcapsular location and the use of an expansion-type needle. Hence, prophylactic ablation of the needle track should be performed whenever possible. Otherwise, alternative routes of tumor ablation such as laparoscopic or open RFA should be considered.

  9. Value of percutaneous radiofrequency ablation with or without percutaneous vertebroplasty for pain relief and functional recovery in painful bone metastases

    Energy Technology Data Exchange (ETDEWEB)

    Clarencon, Frederic; Jean, Betty; Cormier, Evelyne; Chiras, Jacques [Pitie-Salpetriere Hospital, Department of Neuroradiology, Paris (France); Pham, Hang-Phuong; Bensimon, Gilbert [Pitie-Salpetriere Hospital, Department of Clinical Pharmacology, Paris (France); Rose, Michele [Pitie-Salpetriere Hospital, Department of Critical Care, Paris (France); Maksud, Philippe [Pitie-Salpetriere Hospital, Assistance Publique des, Hopitaux de Paris, Department of Nuclear Medicine, Paris (France)

    2013-01-15

    To evaluate the effectiveness of percutaneous radiofrequency (RF) ablation with or without percutaneous vertebroplasty (PV) on pain relief, functional recovery and local recurrence at 6 months' follow-up (FU), in patients with painful osseous metastases. Thirty RF ablations were performed in 24 patients (mean age: 61 years) with bone metastases. Half of the patients had an additional PV. The primary end point was pain relief evaluated by a visual analogue scale (VAS) before treatment, and at 1 and 6 months' FU. Functional outcome was assessed according to the evolution of their ability to walk at 6 months' FU. Imaging FU was available in 20 out of 24 patients with a mean delay of 4.7 months. Reduction of pain was obtained at 6 months FU in 81% of cases (15 out of 18). Mean pretreatment VAS was 6.4 ({+-}2.7). Mean VAS was 1.9 ({+-}2.4) at 1 month FU, and 2.3 ({+-}2.9) at 6 months' FU. Pain was significantly reduced at 6 months FU (mean VAS reduction = 4.1; P < 0.00001). Functional improvement was obtained in 74% of the cases. Major complications rate was 12.5 % (3 out of 24) with 2 skin burns, and 1 case of myelopathy. Local tumour recurrence or progression was recorded in 5 cases. Radiofrequency ablation is an effective technique in terms of pain relief and functional recovery for the treatment of bone metastases, which provides a relatively low rate of local recurrence. (orig.)

  10. Percutaneous radiofrequency thermal ablation of lung VX2 tumors in a rabbit model: evaluation with helical CT findings for the complete and partal ablation

    Energy Technology Data Exchange (ETDEWEB)

    Jin, Gong Yong; Han, Young Min; Lim, Yeong Su; Jang, Kyu Yun; Lee, Sang Yong; Chung, Gyung Ho [School of Medicine, Chonbuk National Univ., Chonju (Korea, Republic of)

    2004-05-01

    To evaluate the radiologic findings for complete and partial ablation after percutaneous CT-guided transthoracic radiofrequency ablation (RFA) of lung VX2 tumor implanted in rabbits. Thirteen rabbits with successfully implanted lung VX2 were used. Three rabbits as controls did not receive RFA while the other ten rabbits underwent RFA; 5 complete and 5 partial. RFA was performed using an internally cooled, 17-gauge electrode (Radionics, Burlington, MA) with a 1-cm active tip under CT guidance. Postprocedural CT was performed within 3 days, and we analyzed the ablated size, enhancement pattern, shape, margin, and complications of the complete and partial ablation groups. Rabbits were sacrificed after postprocedural CT with an overdose of ketamine, and pathologic findings of the ablated groups were compared with those of the control group. The size of the ablated lesions and the enhancement pattern differed between the completely and partially ablated groups on chest CT. The size of the ablated lesions was increased by 47.1% in the completely ablated group and by 2.1% in the partially ablated group. In the completely ablated group, VX2 tumor showed absolutely no enhancement, whereas only ablated pulmonary parenchyma outside VX2 showed mild enhancement on enhanced CT. In the partial ablated group, a part of VX2 became strongly enhanced on enhanced CT. On microscopic examination, the completely ablated group demonstrated that a viable tumor cell was not visible. In the partially ablated group, however, a viable tumor cell within the surrounding fibrous capsule on the peripheral area of the VX2 was observed. The important CT findings for evaluation of complete and partial RFA are the ablated size and enhancement pattern of the ablated lesion.

  11. Duodenopleural Fistula Formation After Percutaneous Radiofrequency Ablation for Recurrent Hepatocellular Carcinoma

    Directory of Open Access Journals (Sweden)

    Fion S. Chan

    2007-10-01

    Full Text Available Radiofrequency ablation (RFA is a treatment option in the management of unresectable or recurrent hepatocellular carcinoma (HCC. It can be performed either through laparotomy or in a minimally invasive manner by percutaneous, laparoscopic or thoracoscopic routes. Percutaneous RFA is associated with reduced surgical trauma and thus can be performed in patients with significant comorbidities. The procedure can be repeated after short intervals for sequential ablation of multiple liver lesions. However, the associated risks should not be underestimated. This is the first report of a rare complication of duodenopleural fistula after percutaneous RFA of a recurrent subcapsular HCC. The risk of bowel perforation during the ablation of subcapsular HCC requires special attention, since only the position of the tip of the electrode, but not the zone of ablation, can be assessed accurately by imaging during the procedure. Our case demonstrated that there was leakage of bowel content from the duodenal injury site into the pleural cavity through the RFA track. Subsequent uncontrolled infection resulted in empyema thoracis and led to the death of the patient.

  12. The usefulness of CT guided drainage of abscesses caused by retained appendicoliths

    Energy Technology Data Exchange (ETDEWEB)

    Buckley, O. [Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Geoghegan, T. [Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Ridgeway, P. [Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Colhoun, E. [Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Snow, A. [Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Torreggiani, W.C. [Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland)]. E-mail: william.torreggiani@amnch.ie

    2006-10-15

    Objectives: To determine the utility of percutaneous computed tomography (CT) guided drainage of abscesses formed secondary to retained appendicoliths. Materials and methods: A retrospective review was conducted over a 5-year period to identify patients who underwent CT guided drainage of abscesses related to retained appendicoliths. Inclusion criteria were a history of prior proven appendicitis treated by laparoscopic appendicectomy, identification of a post-operative abscess related to a visualised retained appendicolith and initial treatment by CT guided drainage. Data regarding initial technical success as well as long-term outcome was recorded in each case. Results: In total, five patients were identified who underwent CT guided abscess drainage related to retained appendicoliths. There were three males and two females (age range 12-54 years). Initial drainage under CT guidance was technically successful in all cases with successful catheter placement and resolution of the abscess cavity. In all five cases however, there was recurrence of abscess formation following catheter removal. In one case, a second attempt with CT guided drainage was performed. Again this was initially successful with abscess recurrence following catheter removal. In all five cases, formal surgical drainage with removal of retained appendicolith resulted in a successful outcome. Conclusion: CT guided percutaneous drainage of intra abdominal abscess secondary to retained appendicoliths is only successful in the short term. Formal surgical drainage and removal of the appendicolith is required for long-term success.

  13. Effectiveness of Computed Tomography Guided Percutaneous Radiofrequency Ablation Therapy for Osteoid Osteoma: Initial Results and Review of the Literature

    Science.gov (United States)

    Karagöz, Erdal; Özel, Deniz; Özkan, Fuat; Özel, Betül Duran; Özer, Özgur; Coşkun, Zafer Ünsal

    2016-01-01

    Summary Background The aim of this retrospective study is to determine our experience of technique success rate, complications and clinical results in long term follow up for computed tomography (CT)-guided radiofrequency ablation [RA] therapy for osteoid osteoma (OO). Material/Methods We performed RA therapy to 18 patients with OO referred to interventional radiology from other clinics primarily from orthopedics; between January 2011 to May 2014. Daytime and nighttime pain intensity of 18 patients was noted according to visual analog scale (VAS). After procedure pain intensity was compared with before one. We also discussed other factors can affect it. Results All procedures were completed technically successful for all patients [100%]. We did not experience any major complication or mortality. However we had 3 minor complications. Pain came back in 1 patient after 5 months from procedure and it was considered as recurrence. Dramatic pain intensity fall was seen in patients after procedure, both daytime and nighttime. However we did not find and statistically significant change in comparison of pain intensity reduce and time needed to return back to routine life when using patients demographic data and lesion size. Conclusions CT guided RA therapy of OO is minimally invasive, effective and secure procedure. PMID:27429671

  14. Percutaneous treatment of hepatocellular carcinoma in patients with cirrhosis: A comparison of the safety of cryoablation and radiofrequency ablation

    Energy Technology Data Exchange (ETDEWEB)

    Dunne, Ruth M., E-mail: rmdunne@partners.org [Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women' s Hospital, 75 Francis Street, Boston, MA 02115 (United States); Shyn, Paul B., E-mail: pshyn@partners.org [Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women' s Hospital, 75 Francis Street, Boston, MA 02115 (United States); Sung, Jeffrey C., E-mail: jcsung@gmail.com [Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women' s Hospital, 75 Francis Street, Boston, MA 02115 (United States); Tatli, Servet, E-mail: statli@partners.org [Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women' s Hospital, 75 Francis Street, Boston, MA 02115 (United States); Morrison, Paul R. [Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women' s Hospital, 75 Francis Street, Boston, MA 02115 (United States); Catalano, Paul J., E-mail: pcata@jimmy.harvard.edu [Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, 450 Brookline Avenue, CLSB 11007, Boston, MA 02215 (United States); Department of Biostatistics, Harvard School of Public Health, Boston, MA 02215 (United States); Silverman, Stuart G., E-mail: sgsilverman@partners.org [Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women' s Hospital, 75 Francis Street, Boston, MA 02115 (United States)

    2014-04-15

    Purpose: To compare the safety of image-guided percutaneous cryoablation and radiofrequency ablation in the treatment of hepatocellular carcinoma in patients with cirrhosis. Materials and methods: This retrospective HIPAA-compliant study received institutional review board approval. Forty-two adult patients with cirrhosis underwent image-guided percutaneous ablation of hepatocellular carcinoma from 2003 to 2011. Twenty-five patients underwent 33 cryoablation procedures to treat 39 tumors, and 22 underwent 30 radiofrequency ablation procedures to treat 39 tumors. Five patients underwent both cryoablation and radiofrequency ablation procedures. Complication rates and severity per procedure were compared between the ablation groups. Potential confounding patient, procedure, and tumor-related variables were also compared. Statistical analyses included Kruskal–Wallis, Wilcoxon rank sum, and Fisher's exact tests. Two-sided P-values <0.05 were considered significant. Results: The overall complication rates, 13 (39.4%) of 33 cryoablation procedures versus eight (26.7%) of 30 radiofrequency ablation procedures and severe/fatal complication rates, two (6.1%) of 33 cryoablation procedures versus one (3.3%) of 30 radiofrequency ablation procedures, were not significantly different between the ablation groups (both P = 0.26). Severe complications included pneumothoraces requiring chest tube insertion during two cryoablation procedures. One death occurred within 90 days of a radiofrequency ablation procedure; all other complications were managed successfully. Conclusion: No significant difference was seen in the overall safety of image-guided percutaneous cryoablation and radiofrequency ablation in the treatment of hepatocellular carcinoma in patients with cirrhosis.

  15. Which patients will benefit from percutaneous radiofrequency ablation of colorectal liver metastases? Critically appraised topic.

    LENUS (Irish Health Repository)

    McGrane, Siobhan

    2012-02-03

    In clinical radiology, there are numerous examples of new techniques that were initially enthusiastically promoted and then subsequently abandoned when early promise was not realized in routine patient care. Appropriateness of new or established interventional radiology techniques to specific clinical conditions must be determined from clinical experience, from communication with experts in the field and\\/or careful review of available medical literature, and on an individual patient basis by means of review of clinical notes and diagnostic imaging studies. For patients with liver neoplasms, regional techniques such as radiofrequency ablation (RFA) have been developed and are now the subject of ongoing research. This article describes the utilization of Evidence-Based Practice (EBP) techniques as a means of deciding the appropriateness of percutaneous RFA in treating colorectal liver metastases (CLM).

  16. Comparison of nerve combing and percutaneous radiofrequency thermocoagulation in the treatment for idiopathic trigeminal neuralgia.

    Science.gov (United States)

    Zhou, Xuanchen; Liu, Yiqing; Yue, Zhiyong; Luan, Deheng; Zhang, Hong; Han, Jie

    2016-01-01

    Idiopathic trigeminal neuralgia (ITN) is a common pain disease in elderly people. Many methods have been used to alleviate the pain of patients, but few studies in the literature have compared the effect of nerve combing and percutaneous radiofrequency thermocoagulation. The purpose of this study was to describe and evaluate the clinical outcome of idiopathic trigeminal neuralgia after nerve combing (NC) and compare them with those obtained using percutaneous radiofrequency thermocoagulation (RF). The study included 105 idiopathic trigeminal neuralgia patients with similar symptom, age and underlying disease, which were divided into two groups. One group was treated by nerve combing (50 patients), the other by RF (55 cases). All patients were considered medical failures prior to the surgeries. A questionnaire was used to assess the long-term outcomes: pain relief, recurrence, complication and need for additional treatment. The median duration of follow-up in both groups was 90 months. Satisfactory relief was noted in 41 patients (82%), 5 patients (10%) initially experienced pain relief, then recurred, and four patients (8%) were designated poor among the group NC. In the group RF, satisfactory relief was noted in 42 patients (76.4%). There were eight "pain free with recurrence patients (14.5%) and 5 poor cases (9.1%). No statistically significant differences existed in the outcomes between both groups (p>0.05). Postoperative morbidity included dysesthesia, diplopia, partial facial nerve palsy, hearing loss, tinnitus, cerebrospinal fluid leak, meningitis and mortality. Nerve combing and RF are both satisfactory treatment strategies for patients with ITN. Because of the higher risk of sensory morbidity and surgical risk as open surgery, RF is preferred as the recommended procedure for patients with ITN. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  17. Comparison of nerve combing and percutaneous radiofrequency thermocoagulation in the treatment for idiopathic trigeminal neuralgia

    Directory of Open Access Journals (Sweden)

    Xuanchen Zhou

    Full Text Available ABSTRACT INTRODUCTION: Idiopathic trigeminal neuralgia (ITN is a common pain disease in elderly people. Many methods have been used to alleviate the pain of patients, but few studies in the literature have compared the effect of nerve combing and percutaneous radiofrequency thermocoagulation. OBJECTIVE: The purpose of this study was to describe and evaluate the clinical outcome of idiopathic trigeminal neuralgia after nerve combing (NC and compare them with those obtained using percutaneous radiofrequency thermocoagulation (RF. METHODS: The study included 105 idiopathic trigeminal neuralgia patients with similar symptom, age and underlying disease, which were divided into two groups. One group was treated by nerve combing (50 patients, the other by RF (55 cases. All patients were considered medical failures prior to the surgeries. A questionnaire was used to assess the long-term outcomes: pain relief, recurrence, complication and need for additional treatment. RESULTS: The median duration of follow-up in both groups was 90 months. Satisfactory relief was noted in 41 patients (82%, 5 patients (10% initially experienced pain relief, then recurred, and four patients (8% were designated poor among the group NC. In the group RF, satisfactory relief was noted in 42 patients (76.4%. There were eight "pain free with recurrence patients (14.5% and 5 poor cases (9.1%. No statistically significant differences existed in the outcomes between both groups (p > 0.05. Postoperative morbidity included dysesthesia, diplopia, partial facial nerve palsy, hearing loss, tinnitus, cerebrospinal fluid leak, meningitis and mortality. CONCLUSION: Nerve combing and RF are both satisfactory treatment strategies for patients with ITN. Because of the higher risk of sensory morbidity and surgical risk as open surgery, RF is preferred as the recommended procedure for patients with ITN.

  18. Incidence of delayed complications following percutaneous CT-guided biopsy of bone and soft tissue lesions of the spine and extremities: A 2-year prospective study and analysis of risk factors

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Ambrose J.; Rosenthal, Daniel I. [Massachusetts General Hospital, Boston, MA (United States); Halpern, Elkan F. [Massachusetts General Hospital, Institute of Technology Assessment, Boston, MA (United States)

    2013-01-15

    To prospectively evaluate the incidence of delayed complications (bleeding, pain, infection) following CT-guided biopsies of bone or soft tissue lesions and to identify risk factors that predispose to their occurrence. All adults presenting for CT-guided biopsy of a bone or soft tissue lesion were eligible for the study. Risk factors considered included patient gender and age, bone versus soft tissue, lesion location, lesion depth, anticoagulation, conscious sedation, coaxial biopsy technique, bleeding during the biopsy, dressing type and duration of placement, final diagnosis, needle gauge, number of passes, and number of days to follow-up. Outcomes measured included fever, pain, bruising/hematoma formation, and swelling and were collected by a follow-up phone call within 14 days of the biopsy. Fisher's exact test, the Wald Chi-square test, and univariate, multivariate, and stepwise logistic regression were performed to evaluate the influence of the risk factors on the outcomes. A total of 386 patients participated in the study. The rates of post-biopsy fever, pain, bruising, and swelling were 1.0, 16.1, 15.6, and 9.6 %, respectively. Anticoagulants were identified as a risk factor for fever. Increasing patient age was identified as a risk factor for pain. Female gender and lesion location were identified as risk factors for bruising. Increasing patient age and lesion location were identified as risk factors for swelling. Patient age, female gender, and lesion location are risk factors for delayed minor complications following CT-guided biopsy of a bone or soft tissue lesion. There were no major complications. None of the complications in this series altered patient management. (orig.)

  19. Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Buscarini, L.; Buscarini, E.; Di Stasi, M. [Dept. of Gastroenterology, General Hospital, Piacenza (Italy); Vallisa, D. [Dept. of Internal Medicine, General Hospital, Piacenza (Italy); Quaretti, P. [Dept. of Radiology, General Hospital, Piacenza (Italy); Rocca, A. [Dept. of Oncology, General Hospital, Piacenza (Italy)

    2001-06-01

    The aim of this study was to evaluate the effectiveness and the safety of percutaneous radiofrequency (RF) thermal ablation of hepatocellular carcinoma (HCC) in 88 patients with a long follow-up, and to compare conventional electrodes and expandable electrodes. Eighty-eight patients with 101 hepatocellular carcinoma nodules ({<=} 3.5 cm in diameter) underwent RF thermal ablation by means of either conventional electrodes or an expandable electrode. Therapeutic efficacy was evaluated with dynamic contrast CT, serum {alpha}-feto protein level, US examination at the end of the treatment, and during follow-up. Complete necrosis was obtained in all tumor nodules in a mean number of 3.3 sessions (tumor treated by conventional electrodes) or 1.5 sessions (tumor treated by expandable electrode). The mean follow-up was 34 months; overall survival rate was 33 % at 5 years. Disease-free survival at 5 years was 3 %; local recurrence rate was 29 % in patients treated with conventional electrodes; 14 % in patients treated with the expandable electrode. Two major complications and 14 minor complications were observed. Radiofrequency thermal ablation in small HCC is very effective with a low percentage of major complications. The use of an expandable electrode substantially reduced the number of treatment sessions but did not modify the overall survival rate and the disease-free survival rate. (orig.)

  20. Ultrasonography-guided percutaneous radiofrequency ablation for cervical lymph node metastasis from thyroid carcinoma

    Directory of Open Access Journals (Sweden)

    Liping Wang

    2014-01-01

    Full Text Available Purpose: The aim was to explore the efficacy and safety of ultrasonography-guided percutaneous radiofrequency ablation (RFA for cervical lymph node metastases from thyroid carcinoma. Materials and Methods: Eight patients with previous total thyroidectomy and radioiodine therapy were enrolled in this study. A total of 20 cervical lymph node metastases were confirmed by percutaneous biopsy. Participants underwent ultrasonography-guided RFA treatment for all confirmed metastatic lymph nodes. Contrast-enhanced ultrasound (CEUS and sonoelastography were performed to rapidly evaluate treatment responses before and shortly after RFA. Routine follow-up consisted of conventional US, CEUS, sonoelastography, thyroglobulin level, and necessary fine needle aspiration cytology. Results: All eight patients were successfully treated without obvious complications. Post-RFA CEUS showed that total metastatic lymph nodes were ablated. The sonoelastographic score of ablated area elevated significantly shortly after RFA (P < 0.001. With a mean follow-up of 9.4 ± 5.1 months, there were no evidences of recurrence at ablated sites; however, two new cervical recurrent lymph nodes occurred in one case, which was successfully ablated as well. The mass volume shrinkages of the ablated nodes were observed in all cases. We found that 5 treated lymph nodes disappeared, 4 were reduced more than 80%, 9 were reduced between 50% and 80%, and 2 were reduced less than 50%. At the last follow-up evaluation, the serum thyroglobulin levels had decreased in 6 of 8 patients. Conclusion: Ultrasonography-guided percutaneous RFA for cervical lymph node metastasis of thyroid malignancy is a feasible, effective, and safe therapy. This procedure shows a nonsurgical therapeutic option for metastatic lymph nodes in patients with difficult reoperations or inoperations, it may reduce or delay a large number of highly invasive repeated neck dissections.

  1. Value of B-FFE MR sequence before CT-guided radiofrequency thermocoagulation for the treatment of primary trigeminal neuralgia%射频热凝术前磁共振B-FFE序列三叉神经成像评估

    Institute of Scientific and Technical Information of China (English)

    胡芸; 金朝林; 王翔; 张树桐; 蔡毅

    2015-01-01

    目的:探讨 CT 定位射频温控热凝治疗原发性三叉神经痛术前,磁共振平衡式快速梯度回波(B-FFE)序列三叉神经成像检查的必要性和临床意义。方法采用B-FFE 序列扫描63例拟行射频温控热凝治疗的原发性三叉神经痛患者的患侧三叉神经,观察三叉神经脑池段、半月神经节及其三大分支的解剖形态、走行方式,半月神经节与卵圆孔之间的位置关系,指导术中CT定位穿刺。结果本研究63例患者中,23例(37%)病变侧三叉神经跨岩骨尖时呈聚拢束状,40例(63%)病变侧三叉神经跨岩骨尖时呈三支分散状。眼神经走行于前内侧,下颌神经走行于后外方,上颌神经则走行于两者之间。三叉神经跨岩骨尖角度(150.11±8.32)°。卵圆孔至半月神经节距离(12.37±3.21) cm。结论三叉神经痛射频热凝温控治疗术前行磁共振B-FFE 序列三叉神经成像检查,明确相应解剖结构关系,可以提高术中 CT 定位的准确性,缩短手术时间,减低手术风险,具有较高的临床实用价值。%Objective To analyze the value of B-FFE MR sequence before CT-guided radiofrequency thermocoagulation for the treatment of primary trigeminal neuralgia..Methods The B-FFE Sequence were performed on 63 patients with primary trigeminal neuralgia before CT-guided radiofrequency thermocoagulation..MR images were analyzed to identify the relationship between trigeminal nerves and surrounding vessels,.the anatomy of trigeminal ganglion in Meckel′s caves and their branches,.the relationship between the trigeminal semilunar ganglion and the oval foramen..Results The affected trigeminal nerve roots were bundled (23/63, 37%) or divided (40/63, 63%) at (150.11±8.32) angle at the petrous apex before entering the Meckel′s caves. The ophthalmic division travelled anteromedially,.maxillary division in the middle,.and mandibular division posterolaterally

  2. Radiofrequency ablation of osteoid osteoma

    NARCIS (Netherlands)

    Vanderschueren, Geert Maria Joris Michael

    2009-01-01

    The main purpose of this thesis was to evaluate the effectiveness and safety of CT-guided radiofrequency ablation for the treatment of spinal and non-spinal osteoid osteomas. Furthermore, the technical requirements needed for safe radiofrequency ablation and the clinical outcome after radiofrequency

  3. Unresectable colorectal liver metastases. Percutaneous ablation using CT-guided high-dose-rate brachytherapy (CT-HDBRT); Nicht resektable kolorektale Lebermetastasen. Perkutane Ablation mittels CT-gesteuerter Hochdosisbrachytherapie (CT-HDBRT)

    Energy Technology Data Exchange (ETDEWEB)

    Collettini, F.; Lutter, A.; Schnapauff, D.; Denecke, T.; Gebauer, B. [Charite, Campus Virchow-Klinikum, Berlin (Germany). Dept. of Diagnostic and Interventional Radiology; Hildebrandt, B. [Charite, Campus Virchow-Klinikum, Berlin (Germany). Dept. of Oncology; Puhl, G. [Charite, Campus Virchow-Klinikum, Berlin (Germany). Dept. of General, Visceral and Transplantation Surgery; Wust, P. [Charite, Campus Virchow-Klinikum, Berlin (Germany). Dept. of Radiation Oncology

    2014-06-15

    Purpose: To evaluate the clinical outcome of CT-guided high-dose-rate brachytherapy (CT-HDRBT) of unresectable colorectal liver metastases (CRLMs). Materials and Methods: Retrospective analysis of all consecutive patients with unresectable CRLMs treated with CT-HDRBT between January 2008 and November 2012. Treatment was performed by CT-guided catheter placement and high-dose-rate brachytherapy with an iridium-192 source. MRI follow-up was performed after 6 weeks and then every 3 months post-intervention. The primary endpoint was local tumor control (LTC); secondary endpoints included time to progression (TTP) and overall survival (OS). Results: 80 heavily pretreated patients with 179 metastases were available for MRI evaluation for a mean follow-up time of 16.9 months. The mean tumor diameter was 28.5 mm (range: 8 - 107 mm). No major complications were observed. A total of 23 (12.9%) local tumor progressions were observed. Lesions ≥ 4 cm in diameter showed significantly more local progression than smaller lesions (< 4 cm). 50 patients (62.5%) experienced systemic tumor progression. The median TTP was 6 months. 28 (43%) patients died during the follow-up period. The median OS after ablation was 18 months. Conclusion: CT-HDRBT is an effective technique for the treatment of unresectable CRLMs and warrants promising LTC rates compared to thermal ablative techniques. A combination with other local and systemic therapies should be evaluated in patients with lesions > 4 cm in diameter, in which higher progression rates are expected. (orig.)

  4. Percutaneous radiofrequency ablation of renal tumors in high-risk patients: 10 years' experience.

    Science.gov (United States)

    Alguersuari, A; Mateos, A; Falcó, J; Criado, E; Fortuño, J R; Guitart, J

    2016-01-01

    To retrospectively evaluate the efficacy and safety of percutaneous radiofrequency ablation (RFA) done to treat renal tumors in patients with high surgical risk or with the risk of developing multiple renal tumors in the medium term at our center over a period of 10 years. Between 2005 and 2015, we used RFA to treat 89 T1a or T1b tumors in 87 patients (mean age, 73.7±10.87 years) with high surgical risk. We excluded patients treated with radiofrequency and embolization or microwave ablation. The tumors treated were clear cell carcinomas (43.6%), papillary renal carcinomas (17.2%), chromophobe renal cell carcinomas (10.3%), cystic tumors (2.2%), and an angiomyolipoma (1.1%). The mean size of the tumors was 2.6cm. Computed tomography and/or ultrasonography were used to guide the procedure. We analyzed the relation between the efficacy of the procedure and patients' age, the type of needle, the source of the patients, the size and location of the tumor, and the number of sessions required to achieve ablation. We recorded all complications. The RFA procedure was completed in all patients. The mean follow-up period was 32.1 months. The efficacy was 93.7%. A single session was sufficient in 87.5% of patients; 8% required two sessions and 4.5% required three sessions. The only factor associated with worse efficacy was the size of the tumor (p=0.03). The rate of complications was 5.6%. RFA is efficacious and safe, with results comparable to those reported in the literature. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Value of CT-guided percutaneous lung biopsy in diagnosing non-small cell lung cancer compared with biopsy from surgical approach%两种方法获得的非小细胞肺癌标本病理结果的差异

    Institute of Scientific and Technical Information of China (English)

    李波; 王菁; 李月川

    2015-01-01

    目的:探讨CT引导下经皮肺穿刺活检标本病理结果的可靠性,及其对非小细胞肺癌的诊断价值。方法选择非小细胞肺癌患者91例,影像学检查发现肺部肿物,经痰液细胞学、支气管镜的涂片细胞学或活检组织学等检查,均未能明确诊断的肺部病变患者,后经CT引导下经皮肺内病灶穿刺术,获得涂片细胞学和(或)活检组织学证据,明确诊断为非小细胞肺癌,再行外科手术切除获得完整的病理结果。比较CT引导下经皮肺穿刺活检不同病理类型及不同途径的病理结果与外科手术切除标本的病理结果的差异。结果 CT引导下经皮肺穿刺活检的病理结果与手术结果的符合率为86.81%(79/91)。与手术病理结果比较,经皮肺穿刺活检不同病理类型的符合率差异无统计学意义[鳞癌vs腺癌vs腺鳞癌:88.57%(31/35) vs 86.27%(44/51) vs 80.00%(4/5),χ2=0.310,P>0.05];经皮肺穿刺标本采用不同方法的病理类型结果与手术结果的比较差异有统计学意义(χ2=9.698,P<0.05),经涂片细胞学+活检组织学获得病理结果的符合率[94.4%(51/54)]高于单独涂片细胞学[60.0%(6/10)]和单独活检组织学[81.4%(22/27)]。结论CT引导下经皮肺穿刺活检对非小细胞肺癌的定性诊断是可靠的,但其病理类型结果可能与手术结果不一致。%Objective To investigate the reliability of CT-guided percutaneous lung biopsy pathological results in diag⁃nosing Non-small cell lung cancer (NSCLC). Methods Patients (n=91) were selected whose radiology examination re⁃vealed pulmonary masses but were failed to be confirmed with pulmonary lesion through sputum or bronchoscopy. Then, they were diagnosed as non-small cell lung cancer by CT-guided percutaneous lung biopsy. After that, they received surgical op⁃eration and biopsies were taken during operations for pathological analysis. Pathological results between from

  6. Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment

    Institute of Scientific and Technical Information of China (English)

    Yi-Bin Hou; Min-Hua Chen; Kun Yan; Jin-Yu Wu; Wei Yang

    2009-01-01

    AIM: To evaluate the feasibility and efficacy of percutaneous radiofrequency ablation (RFA) of the feeding artery of hepatocellular carcinoma (HCC) in reducing the blood-flow-induced heat-sink effect of RFA.METHODS: A total of 154 HCC patients with 177 pathologically confirmed hypervascular lesions participated in the study and were randomly assigned into two groups. Seventy-one patients with 75 HCCs (average tumor size, 4.3 ± 1.1 cm) were included in group A, in which the feeding artery of HCC was identified by color Doppler flow imaging, and were ablated with multiple small overlapping RFA foci [percutaneous ablation of feeding artery (PAA)] before routine RFA treatment of the tumor. Eighty-three patients with 102 HCC (average tumor size, 4.1 ± 1.0 cm) were included in group B, in which the tumors were treated routinely with RFA. Contrast-enhanced computed tomography was used as post-RFA imaging, when patients were followed-up for 1, 3 and 6 mo.RESULTS: In group A, feeding arteries were blocked in 66 (88%) HCC lesions, and the size of arteries decreased in nine (12%). The average number of punctures per HCC was 2.76 ± 1.12 in group A, and 3.36 ± 1.60 in group B ( P = 0.01). The tumor necrosis rate at 1 mo post-RFA was 90.67% (68/75 lesions) in group A and 90.20% (92/102 lesions) in group B. HCC recurrence rate at 6 mo post-RFA was 17.33% (13/75) in group A and 31.37% (32/102) in group B ( P = 0.04).CONCLUSION: PAA blocked effectively the feeding artery of HCC. Combination of PAA and RFA significantly decreased post-RFA recurrence and provided an alternative treatment for hypervascular HCC.

  7. Percutaneous radiofrequency ablation - clinical indications and results; Perkutane Radiofrequenzablation - klinische Indikationen und Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Tacke, J. [Universitaetsklinikum Aachen (Germany). Klinik fuer Radiologische Diagnostik

    2003-02-01

    Percutaneous interstitial tumor ablation therapy is a relatively new and steadily growing field within interventional radiology. Radiofrequency ablation (RFA) became one of the most accepted techniques among hyperthermal ablation procedures, presumably due to its superior relation between probe diameter and efficacy. The first part of this review provided an overview of the underlying principles, technical background and application techniques. This second part describes the indications, techniques and results of clinical RFA applied to primary and secondary liver tumors as well as experiences with extrahepatic RFA applied to kidney, bone and lung, together with a discussion of the current literature. (orig.) [German] Die perkutane interstitielle Tumortherapie stellt innerhalb der interventionellen Radiologie ein noch junges, sich aber stetig weiterentwickelndes Verfahren dar. Unter den Thermoablationsverfahren hat die Radiofrequenzablation (RFA) die weiteste Verbreitung gefunden, nicht zuletz aufgrund des guenstigen Verhaeltnisses von Sonderdurchmesser und Wirkungsrad. Die Grundlagen, technischen Hintergruende und Applikationstechniken wurden im ersten Teil der Uebersichtsarbeit zur perkutanen Radiofrequenzablation beschrieben. In diesem zweiten Teil werden die Indikationen, Techniken und Ergebnise der klinischen RFA primaerer und sekundaerer Lebertumoren sowie Erfahrungen der extrahepatischen RFA im Bereich der Niere, des Knochens und der Lunge vorgestellt und anhand der Literatur diskutiert. (orig.)

  8. Ultrasound-guided percutaneous radiofrequency ablation of liver tumors: How we do it safety and completely

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Woong; Shin, Sang Soo; Heo, Suk Hee; Hong, Jun Hyung; Lim, Hyo Soon; Seon, Hyun Ju; Hur, Young Hoe; Park, Chang Hwan; Jeong, Yong Yeon; Kang, Heoung Keun [Chonnam National University Medical School, Gwangju (Korea, Republic of)

    2015-12-15

    Ultrasound-guided percutaneous radiofrequency (RF) ablation has become one of the most promising local cancer therapies for both resectable and nonresectable hepatic tumors. Although RF ablation is a safe and effective technique for the treatment of liver tumors, the outcome of treatment can be closely related to the location and shape of the tumors. There may be difficulties with RF ablation of tumors that are adjacent to large vessels or extrahepatic heat-vulnerable organs and tumors in the caudate lobe, possibly resulting in major complications or treatment failure. Thus, a number of strategies have been developed to overcome these challenges, which include artificial ascites, needle track ablation, fusion imaging guidance, parallel targeting, bypass targeting, etc. Operators need to use the right strategy in the right situation to avoid the possibility of complications and incomplete thermal tissue destruction; with the right strategy, RF ablation can be performed successfully, even for hepatic tumors in high-risk locations. This article offers technical strategies that can be used to effectively perform RF ablation as well as to minimize possible complications related to the procedure with representative cases and schematic illustrations.

  9. Percutaneous radiofrequency ablation of osteoid osteomas. Technique and results; Perkutane Radiofrequenzablation von Osteoidosteomen. Technik und Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Bruners, P.; Penzkofer, T. [Lehrstuhl fuer Angewandte Medizintechnik, Helmholtz Inst. fuer Biomedizinische Technik, RWTH Aachen (Germany); Guenther, R. W.; Mahnken, A. [Klinik fuer Radiologische Diagnostik, Universitaetsklinikum RWTH Aachen (Germany)

    2009-08-15

    Purpose: Osteoid osteoma is a benign primary bone tumor that typically occurs in children and young adults. Besides local pain, which is often worse at night, prompt relief due to medication with acetylsalicylic acid (ASS) is characteristic for this bone lesion. Because long-term medication with ASS does not represent an alternative treatment strategy due to its potentially severe side effects, different minimally invasive image-guided techniques for the therapy of osteoid osteoma have been developed. In this context radiofrequency (RF) ablation in particular has become part of the clinical routine. The technique and results of image-guided RF ablation are compared to alternative treatment strategies. Materials and Methods: Using this technique, an often needle-shaped RF applicator is percutaneously placed into the tumor under image guidance. Then a high-frequency alternating current is applied by the tip of the applicator which leads to ionic motion within the tissue resulting in local heat development and thus in thermal destruction of the surrounding tissue including the tumor. Results: The published primary and secondary success rates of this technique are 87 and 83%, respectively. Surgical resection and open curettage show comparable success rates but are associated with higher complication rates. In addition image-guided RF ablation of osteoid osteomas is associated with low costs. (orig.)

  10. Single-session combined therapy with chemoembolization and DSA-CT guided radiofrequency ablation in hepatocellular carcinoma larger than 5 cm:A primary clinical study%肝动脉化疗栓塞联合同步DSA-CT引导下射频消融治疗大肝癌的临床研究

    Institute of Scientific and Technical Information of China (English)

    王志军; 王茂强; 段峰; 宋鹏; 刘凤永; 常中飞; 王燕; 阎洁羽; 李凯

    2014-01-01

    ObjectiveTo assess the safety and efifcacy of single-session combined therapy with transcatheter arterial chemoembolization (TACE) and DSA-CT guided radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) larger than 5 cm.Methods A total of 21 patients were treated with TACE immediately followed by DSA-CT-guided RFA. Rate of technical success, local-regional tumor response, recurrence-free survival time, survival rate and complications were evaluated at follow-up images and AFP (α-fetoprotein).Results Technical success was achieved in all 25 visible HCC. No major complications was observed in any patient. Nineteen patients were complete response (CR) and 2 were partial response (PR) after the 1st months. Coagulation necrosis was the major appearance. CR occupied 90.48% (19/21). PR occupied 9.52% (2/21). Local-regional tumor response in solitary nodular lesions (17/17, 100%) was superior to multiple nodular lesions (2/4, 50.00%;P=0.034). During follow-up period, mean recurrence-free survival time was 11.8±6.0 months in 19 cases with CR. The estimated overall survival rate at 6, 12 months and 18 months was 100%.Conclusions Single-session combined therapy with TACE and DSA-CT guided RFA in large hepatocellular carcinoma was safe and effective, especially for solitary nodular lesions.%目的:评估肝动脉化疗栓塞(TACE)联合同步DSA-CT引导下射频消融(RFA)治疗大肝癌(肿瘤最大直径≥5 cm)的安全性和疗效。方法2010年1月~2012年3月21例原发性肝细胞癌患者接受同步联合治疗。术后定期进行影像学检查并复查甲胎蛋白,评估联合技术成功率、局部肿瘤治疗反应、无疾病复发时间、患者存活情况和技术相关并发症。结果技术成功率100%,无重要并发症发生。介入术后1个月复查,病灶完全缓解19例(19/21,90.48%)、部分缓解2例(2/21,9.52%)。肿瘤坏死以凝固性坏死为主。在局部灭活肿瘤方面,

  11. Study on the clinical efficacy of CT guided percutaneous argon helium knife for the treatment of metastatic bone tumor%CT 引导下经皮穿刺氩氦刀冷冻技术对转移性骨肿瘤的临床疗效观察与研究

    Institute of Scientific and Technical Information of China (English)

    赵朝阳; 邓少杰; 叶军; 张在恒; 刘文华

    2016-01-01

    目的:观察研究 CT 引导下经皮穿刺氩氦刀冷冻技术对转移性骨肿瘤的临床疗效。方法选取我院98例转移性骨肿瘤患者,回顾性分析上述患者临床治疗效果,比较患者治疗前后视觉模拟评分(VAS)及卡氏功能状态评分标准(KPS)评分变化,以及术后不良反应及并发症发生情况,总结 CT 引导下经皮穿刺氩氦刀冷冻技术优缺点。结果98例转移性骨肿瘤患者,均穿刺获得满意标本,一次性成功。其中活检穿刺发现肺癌骨转移人数最多,共72例,占73.47%,其次为肝癌骨转移,共19例,占19.39%,恶性黑色素瘤7例,占7.14%。本组98例 CT 引导下经皮穿刺氩氦刀冷冻治疗后并发症发生率为30.06%(30/98),其中血压升高严重者为3例,占3.06%,皮肤严重冻伤者1例,占1.02%。98例患者治疗后 VAS 和 KPS 评分较治疗前有显著下降(P <0.01)。结论 CT 引导下经皮穿刺氩氦刀冷冻技术不仅可以达到与常规方法治疗的准确率,且对恶性病灶的敏感度高,氩氦刀冷冻组织时定位准确,创口小,成功度较高,在保留骨诱导活性和保存肢体的前提下进行治疗。对转移性骨肿瘤患者进行 CT 引导下经皮穿刺氩氦刀冷冻治疗在降低局部复发率,保留骨诱导活性以及改善关节功能方面的临床应用前景广阔。%Objective To observe the clinical effect of CT guided percutaneous argon helium knife in the treatment of metastatic bone tumor.Methods Ninety-eight patients with metastatic bone tumor in our hospital were analyzed retrospectively.The clinical treatment and changes of VAS and KPS score were studied.Results 98 cases of patients with metastatic bone tumor were successfully sampled.Biopsy puncture showed that the largest number of lung cancer bone metastasis is 72,accounting for 73.47%;followed by 19 cases of bone metastasis of liver cancer,accounting for

  12. Percutaneous CT-guided high-dose brachytherapy (CT-HDRBT) ablation of primary and metastatic lung tumors in nonsurgical candidates; Perkutane CT-gesteuerte Hochdosis-Brachytherapie (CT-HDRBT) von primaeren und metastatischen Lungentumoren in nicht chirurgischen Kandidaten

    Energy Technology Data Exchange (ETDEWEB)

    Collettini, F.; Schnapauff, D.; Poellinger, A.; Denecke, T.; Banzer, J.; Golenia, M.J.; Gebauer, B. [Charite - Universitatesmedizin Berlin (Germany). Inst. fuer Radiologie; Wust, P. [Charite - Universitatesmedizin Berlin (Germany). Klinik fuer Strahlentherapie

    2012-04-15

    To evaluate the safety and efficacy of CT-guided high-dose brachytherapy (CT-HDRBT) ablation of primary and metastatic lung tumors. Between November 2007 and May 2010, all consecutive patients with primary or metastatic lung tumors, unsuitable for surgery, were treated with CT-HDRBT. Imaging follow-up after treatment was performed with contrast-enhanced CT at 6 weeks, 3 months and every 6 months after the procedure. The endpoints of the study were local tumor control and time to progression. The Kaplan-Meier method was used to estimate survival functions and local tumor progression rates. 34 procedures were carried out on 33 lesions in 22 patients. The mean diameter of the tumors was 33.3 mm (SD = 20.4). The first contrast-enhanced CT showed that complete ablation was achieved in all lesions. The mean minimal tumor enclosing dose was 18.9 Gy (SD = 2). Three patients developed a pneumothorax after the procedure. The mean follow-up time was 13.7 (3 - 29) months. 2 of 32 lesions (6.25 %) developed a local tumor progression. 8 patients (36.3 %) developed a distant tumor progression. After 17.7 months, 13 patients were alive and 9 patients had died. CT-HDRBT ablation is a safe and attractive treatment option for patients with lung malignancies and allows targeted destruction of tumor tissue with simultaneous preservation of important lung structures. Furthermore, CT-HDRBT is independent of the size of the lesion and its location within the lung parenchyma. (orig.)

  13. Extra-pleuric coaxial system for CT-guided percutaneous fine-needle aspiration biopsy (FNAB) of small (≤20 mm) lung nodules: a novel technique using multiplanar reconstruction (MPR) images.

    Science.gov (United States)

    Capasso, Raffaella; Nizzoli, Rita; Tiseo, Marcello; Pedrazzi, Giuseppe; Brunese, Luca; Rotondo, Antonio; De Filippo, Massimo

    2017-02-01

    The aim of the study is to present the diagnostic feasibility, usefulness, and safety of a novel technique for coaxial CT-guided fine-needle aspiration biopsy of small (≤20 mm in diameter) lung nodules. A 18-gauge (G) (1.2 × 40 mm) needle is inserted through the skin in the depth of the thoracic wall tissues remaining outside the pleura. Its positioning is planned and adjusted using multiplanar reconstruction (MPR) images along the 18-G guide needle axis tracing a reference outline extended from the needle tip to the target nodule. When the insertion of the 18-G extra-pleuric needle (EPN) proves to be precise, a 22-G Chiba needle is then passed through the outer 18-G EPN until it reaches the thoracic lesion for the sampling procedure. Patient population included 153 males and 94 females, with a mean age of 61.3 ± 21.6 years. Mean nodule diameter was 14.1 ± 2.2 mm. The lesion depth from pleural plane ranged from 0 mm to 127 mm. An average of 1.29 aspirates were performed per lesion. The most common complication was pneumothorax in 27 cases; there were no cases of PNX requiring chest tube insertion. Intrapulmonary bleeding along the needle track was observed in 32 patients. Exploiting the advantage of MPR images, our novel technique of extra-pleuric coaxial system with a 18-G EPN allows the operator to multiple samplings of small (≤20 mm) target lesions in various locations with a thinner (22-G Chiba) needle, thus reducing the degree of pleural, parenchymal, or adjacent organs damage.

  14. Percutaneous Radiofrequency Ablation of Lung Cancer Presenting as Ground-Glass Opacity

    Energy Technology Data Exchange (ETDEWEB)

    Iguchi, Toshihiro, E-mail: iguchi@ba2.so-net.ne.jp; Hiraki, Takao, E-mail: takaoh@tc4.so-net.ne.jp; Gobara, Hideo, E-mail: gobara@cc.okayama-u.ac.jp; Fujiwara, Hiroyasu, E-mail: hirofujiwar@gmail.com; Matsui, Yusuke, E-mail: wckyh140@yahoo.co.jp [Okayama University Medical School, Department of Radiology (Japan); Soh, Junichi, E-mail: soh-j@cc.okayama-u.ac.jp; Toyooka, Shinichi, E-mail: shintoyooka@gmail.com [Okayama University Medical School, Department of General Thoracic Surgery (Japan); Kiura, Katsuyuki, E-mail: kkiura@md.okayama-u.ac.jp [Okayama University Medical School, Department of Respiratory Medicine (Japan); Kanazawa, Susumu, E-mail: susumu@cc.okayama-u.ac.jp [Okayama University Medical School, Department of Radiology (Japan)

    2015-04-15

    PurposeWe retrospectively evaluated the outcomes of lung cancer patients presenting with ground-glass opacity (GGO) who received radiofrequency ablation (RFA).MethodsSixteen patients (5 men and 11 women; mean age, 72.6 years) with 17 lung cancer lesions showing GGO (mean long axis diameter, 1.6 cm) underwent a total of 20 percutaneous computed tomography (CT) fluoroscopy-guided RFA sessions, including three repeated sessions for local progression. Lung cancer with GGO was defined as a histologically confirmed malignant pulmonary lesion with a GGO component accounting for >50 % of the lesion on high-resolution CT. Procedure outcomes were evaluated.ResultsThere were no major complications. Pneumothorax occurred in 15 of 20 treatment sessions: 14 were asymptomatic, and 1 required chest tube placement but resolved satisfactorily within 48 h. Minor pulmonary hemorrhage occurred in two and mild pneumonitis in one. The median tumor follow-up period was 61.5 (range 6.1–96.6) months. The effectiveness rates of the primary and secondary techniques were 100 and 100 % at 1 year, 93.3 and 100 % at 2 years, and 78.3 and 92.3 % at 3 years, respectively. The median patient follow-up period was 65.6 (range 6.1–96.6) months. One patient died owing to recurrent other cancer 11.7 months after RFA, whereas the other 15 remained alive. Overall survival and disease-specific survival rates were 93.3 and 100 % at 1 year and 93.3 and 100 % at 5 years, respectively.ConclusionsRFA for lung cancer with GGO was safe and effective, and resulted in promising survival rates.

  15. Percutaneous radiofrequency ablation (RFA) or robotic radiosurgery (RRS) for salvage treatment of colorectal liver metastases

    Energy Technology Data Exchange (ETDEWEB)

    Stintzing, Sebastian; Hendrich, Saskia; Heinemann, Volker [Dept. of Medical Oncology and Comprehensive Cancer Center, Klinikum Grosshadern, LMU, Munich (Germany)], E-mail: sebastian.stintzing@med.uni-muenchen.de; Grothe, Alexander; Trumm, Christoph G. [Dept. of Clinical Radiology, Univ. Hospital Grosshadern, LMU Munich, Munich (Germany); Hoffmann, Ralf-Thorsten [Dept. and Policlinics of Diagnostic Radiology, Universitaetsklinikum Carl Gustav Carus Dresden (Germany); Rentsch, Markus [Dept. of Surgery, Univ. Hospital Grosshadern, LMU Munich, Munich (Germany); Fuerweger, Christoph; Muacevic, Alexander [European Cyberknife Center Munich, Munich (Germany)

    2013-06-15

    Background. Stereotactic radiation therapy is an evolving modality to treat otherwise unresectable liver metastases. In this analysis, two local therapies: 1) single session robotic radiosurgery (RRS) and 2) percutaneous radiofrequency ablation (RFA) were compared in a total of 60 heavily pretreated colorectal cancer patients. Methods. Thirty patients with a total of 35 colorectal liver metastases not qualifying for surgery that were treated in curative intent with RRS were prospectively followed. To compare efficacy of both treatment modalities, patients treated with RFA during the same period of time were matched according to number and size of the treated lesions. Local tumor control, local disease free survival (DFS), and freedom from distant recurrence (FFDR) were analyzed for effi cacy. Treatment-related side effects were recorded for comparison. Results. The median diameter of the treated lesions was 33 mm (7-53 mm). Baseline characteristics did not differ significantly between the groups. One- and two-year local control rates showed no signifi cant difference but favored RRS (85% vs. 65% and 80% vs. 61%, respectively). A signifi cantly longer local DFS of patients treated with RRS compared to RFA (34.4 months vs. 6.0 months; p 0.001) was found. Both, median FFDR (11.4 months for RRS vs. 7.1 months for RFA p=0.25) and the recurrence rate (67% for RRS and 63% for RFA, p>0.99) were comparable. Conclusion. Single session RRS is a safe and effective method to treat colorectal liver metastases. In this analysis, a trend towards longer DFS was seen in patients treated with RRS when compared to RFA.

  16. Percutaneous Vertebroplasty for Pain Management in Patients with Multiple Myeloma: Is Radiofrequency Ablation Necessary?

    Energy Technology Data Exchange (ETDEWEB)

    Orgera, Gianluigi [Sapienza Rome University, Department of Radiology, S. Andrea Hospital (Italy); Krokidis, Miltiadis, E-mail: mkrokidis@hotmail.com [Cambridge University Hospitals NHS Trust, Department of Radiology (United Kingdom); Matteoli, Marco; Varano, Gianluca Maria [Sapienza Rome University, Department of Radiology, S. Andrea Hospital (Italy); La Verde, Giacinto [Sapienza Rome University, Department of Medical Oncology, S. Andrea Hospital (Italy); David, Vincenzo; Rossi, Michele [Sapienza Rome University, Department of Radiology, S. Andrea Hospital (Italy)

    2013-05-08

    PurposeThis study was designed to investigate the added role of radiofrequency ablation (RFA) to vertebroplasty on the pain management of patients with multiple myeloma (MM).MethodsThirty-six patients (51–82 years) with vertebral localization of MM were randomly divided into two groups: 18 patients (group A) who underwent RFA and then vertebroplasty, and 18 patients (group B) who underwent only vertebroplasty. Primary endpoints were technical success and pain relief score rate measured by the visual analogue pain scores (VAS) and Roland–Morris Questionnaire (RMQ); secondary endpoint was the amount of administered analgesia. Survival and complications were compared.ResultsTechnical success was 100 % in both groups. The VAS score (at 24 h and 6 weeks postprocedure) decreased in equal manner for both groups from a mean of 9.1–3.4 and 2.0 for group A and from a mean of 9.3–3.0 and 2.3 for group B; RMQ mean score was 19.8 for group A and 19.9 for group B and decreased to a mean of 9.6 and 8.2 for group A and 9.5 and 8.7 for group B. The amount of medication was equally decreased in the two groups. No statistically significant difference was noted. No major complication occurred and two patients died from other causes.ConclusionsThe use of percutaneous vertebroplasty alone appears to be effective for the pain management of the patients with vertebral involvement of multiple myeloma. The use of RFA that includes cost and time does not offer any clear added benefit on the midterm pain management of such patients.

  17. Role of contrast-enhanced ultrasonography in percutaneous radiofrequency ablation of liver metastases and efficacy evaluation

    Institute of Scientific and Technical Information of China (English)

    Jie Wu; Wei Yang; Shanshan Yin; Jinyu Wu; Wei Wu; Kun Yan; Minhua Chen

    2013-01-01

    Objective:To retrospectively investigate the role of contrast-enhanced ultrasonography (CEUS) in percutaneous radiofrequency ablation (RFA) in patients with liver metastases and evaluate the therapeutic efficacy of RFA assisted by CEUS.Methods:From May 2004 to September 2010,136 patients with 219 liver metastatic lesions received CEUS examination 1 h before RFA (CEUS group),and other 126 patients with 216 lesions without CEUS examination in the earlier period were served as a historical control group.The mean tumor size was 3.2 cm and the mean tumor number was 1.6 in the CEUS group,while 3.4 cm and 1.7 in the control group,respectively (P>0.05).The clinical characteristics,recurrence results and survival outcomes were compared between two groups.Results:In the CEUS group,two isoechoic tumors were not demonstrated on unenhanced ultrasonography (US),and 63 (47%) of 134 tumors examined with CEUS were 0.3 cm larger than with unenhanced US.Furthermore,in 18.4% of 136 patients,additional 1-3 tumors were detected on CEUS.The CEUS group showed higher early tumor necrosis and lower intrahepatic recurrence than the control group.The 3-year overall survival (OS) rate and the 3-year local recurrence-free survival (LRFS) rate in the CEUS group were 50.1% and 38.3%,in contrast to 25.3% and 19.3% in the control group,respectively (P=0.002 and P<0.001).Conclusions:CEUS provides important information for RFA treatment in patients with liver metastases and better therapeutic effect could be attained.

  18. Osteoid osteoma treated with percutaneous radiofrequency ablation: MR imaging follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Min Hee [Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-dong, Jongro-gu, Seoul 110-746 (Korea, Republic of)], E-mail: min.h.lee@samsung.com; Ahn, Joong Mo; Chung, Hye Won; Lim, Hyo K.; Suh, Jae Gon; Kwag, Hyon Joo; Hong, Hyun Pyo; Kim, Byung Moon [Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-dong, Jongro-gu, Seoul 110-746 (Korea, Republic of)

    2007-11-15

    Purpose: We evaluated follow-up magnetic resonance (MR) images for osteoid osteoma treated with percutaneous radiofrequency ablation (RFA). Materials and methods: Sixteen patients with osteoid osteoma treated with RFA underwent follow-up MR imaging. The protocol included T1, T2 and contrast-enhanced (CE) T1-weighted images with fat saturation at each visit immediately for 17 months after the treatment. MR images were jointly reviewed by two radiologists, regarding the appearance of treated areas, presence of complications, and the best sequence for visualization of signal intensity (SI) changes. The therapeutic response was evaluated to be a clinical success with the relief of pain. Results: The treated areas had a target-like appearance on MR images: a central ablated zone (Z1) surrounded by a band (Z2), and a peripheral area (Z3). Z1 was a non-enhancing, hypointense core on T1, T2WI. Z2 was a well-enhancing, hyperintense rim on T2WI. Z3 was less hyperintense and less enhanced than Z2. All nidi were within Z1. This appearance became evident from 1 week to 1 and 2 months. Following up after 2 months, Z2 showed progressive inward enhancement from the periphery, resulting in almost complete enhancement of Z1 and Z2 with a diminishing size. Z3 gradually showed a decrease in signal change and enhancement. No complications were found. CE-T1WI was the best for visualizing SI changes. The clinical success was achieved in all patients except for one patient with a recurrence at 17 months following treatment that had a second ablation. Conclusion: MR imaging demonstrated a characteristic appearance and subsequent changes of treated areas for osteoid osteoma following RFA.

  19. CT 引导下经皮椎体成形术治疗骨质疏松椎体压缩骨折的疗效评价%Clinical efficacy of CT -guided percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures

    Institute of Scientific and Technical Information of China (English)

    徐玉生; 朱海洋; 钟斌; 崔浩; 汪鑫; 理阳

    2016-01-01

    目的:评估 CT 精确引导下经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折的疗效及其并发症的预防。方法87例脊柱病变患者(共98个伤椎)行 CT 精确引导下经皮椎体成形术,记录术前、术后患者视觉模拟疼痛评分(visual analogue scale,VAS)、Oswestry 功能障碍指数(oswestry disability index,ODI)以及远期疗效评估,并对结果进行统计学分析。结果术中应用优化的 CT 引导经皮椎体穿刺成功率100.00%,注入骨水泥2~9 ml,平均(4.17±1.34)ml。VAS 评分术前(7.96±0.48)分,术后6月(1.89±0.47)分;术前 ODI 平均(72.85±6.84)分、术后6个月(9.24±8.30)分;两指标术后与术前比较,差异具有统计学意义(P <0.05)。远期疗效 WHO 评估:总有效率为97.70%。术后即刻 CT证实,共4例患者发生无症状性骨水泥渗漏,其中1例出现暂时性神经根性痛。结论术中 CT 精确引导可优化椎体成形术的手术操作,有效控制椎体骨折引起的疼痛,提高患者的生活质量,是一种微创、安全、高效的治疗方法。%Objective To assess the clinical efficacy of intraoperative CT -guided percutaneous vertebroplasty (PVP)in the treatment of osteoporotic vertebral compression fractures and prevention of complications.Methods Total 98 fracture vertebra of the 87 cases with vertebra accepted optimization of accurate CT -guided percutaneous vertebroplasty.The visual analogue scale, oswestry disability index and long -term curative effect evaluation in preoperation and postoperation were recorded,and the re-sults were statistically analyzed.Results The success rate of optimized CT -guided PVP was 1 00.00%.Bone cements were in-jected 2 ~9 ml,with an average of (4.1 7 ±1 .34)ml.The average score of VAS were (7.96 ±0.48)and (1 .89 ±0.47) scores at preoperation and last follow up after the operation respectively

  20. CT-guided thoracic sympathetic blockade for palmar hyperhidrosis: Immediate results and postoperative quality of life.

    Science.gov (United States)

    Guo, Jian-Guo; Fei, Yong; Huang, Bing; Yao, Ming

    2016-12-01

    The purpose of this study was to evaluate the results, complications, and degree of satisfaction among patients who underwent a CT-guided percutaneous puncture thoracic sympathetic blockade. A total of 186 patients underwent CT-guided thoracic sympathetic blockade based on case histories and a prospective pre- and postoperative questionnaire survey. The study sample was composed of 93 patients with an age range from 18 to 34years and a diagnosis with primary palmar hyperhidrosis (severe in some patients). Percutaneous puncture thoracic sympathetic blockade guided by CT was performed under local anesthesia in all patients. Heart rate (HR), non-invasive blood pressure (NIBP), arterial oxygen saturation (SPO2), perfusion index (PI), and palmar temperature (T) were monitored before and after treatment. Follow-up included a questionnaire on life quality and degree of satisfaction. Ten minutes after treatment, the SPO2, PI, and temperature all raised remarkably ([92.75±2.02]% vs. [98.85±1.09]%, [1.55±0.69]% vs. [8.60±0.94]%, [30.95±1.27]°C vs. [35.75±0.55]°C, respectively, Phyperhidrosis, 87.6% reported improvement in their quality of life. CT-guided percutaneous puncture thoracic sympathetic blockade is a safe, effective, and minimally invasive technique for the treatment of palmar hyperhidrosis. Despite the high rate of compensatory hyperhidrosis, it produces a high rate of patient satisfaction.

  1. CT-guided core-needle biopsy in the diagnosis of mediastinal lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Sklair-Levy, M.; Shaham, D.; Applbaum, Y.H.; Libson, E. [Dept. of Radiology, Hadassah University Hospital, Jerusalem (Israel); Polliack, A.; Gillis, S.; Ben-Yehuda, D. [Dept. of Haematology, Hadassah University Hospital, Jerusalem (Israel); Sherman, Y. [Dept. of Pathology, Hadassah University Hospital, Jerusalem (Israel)

    2000-05-01

    The advent of radiologic guidance techniques for percutaneous biopsy has changed the approach to the routine diagnosis of mediastinal lymphoma. The aim of the present study was to evaluate the diagnostic accuracy of CT-guided percutaneous core-needle biopsy (PCNB) in the clinical management of patients with mediastinal lymphoma. The results of 49 CT-guided PCNB of mediastinal lymphoma performed under local anesthesia in 42 ambulatory patients were analyzed. A positive diagnosis of lymphoma was obtained in 30 of 42 patients, with an overall success rate of 71.5 %. The technique was equally successful in the diagnosis of Hodgkin's and non-Hodgkin's lymphoma. There were no major complications. Percutaneous CT-guided CNB of mediastinal lymphoma is a quick, safe, accurate, and efficient alternative to open biopsy in the evaluation of mediastinal lymphoma, mainly at presentation. It should become the preferred initial diagnostic procedure for obtaining histologic samples in patients with suspected mediastinal lymphoma. (orig.)

  2. Neuronavigator-guided percutaneous radiofrequency thermocoagulation in the treatment of intractable trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    XU Shu-jun; ZHANG Wen-hua; CHEN Teng; WU Cheng-yuan; ZHOU Mao-de

    2006-01-01

    Background Percutaneous radiofrequency thermocoagulation of the trigeminal ganglion (PRTTG) is regarded as the first choice for most patients with trigeminal neuralgia (TN) because of its safety and feasibility. However,neuronavigator-guided PRTTG has been seldom reported. The purpose of this study was to assess the safety and efficacy of neuronavigator-guided PRTTG for the treatment of intractable TN.Methods Between January 2000 and December 2004, 54 patients with intractable TN were enrolled into this study and were randomly divided into two groups. The patients in navigation group (n=26) underwent PRTTG with frameless neuronavigation, and those in control group (n=28) received PRTTG without neuronavigation.Three months after the operation, the efficacy, side effects, and complications of the surgery were recorded. The patients in the control group were followed up for 10 to 54 months (mean, 34±5), and those in the navigation group were followed up for 13 to 58 months (mean, 36±7). Kaplan-Meier analyses of the pain-free survival curves were used for the censored survival data, and the log-rank test was used to compare survival curves of the two groups.Results The immediate complete pain-relief rate of the navigation group was 100%, whereas it was 95% in the control. The proportion of sustained pain-relief rates at 12, 24 and 36 months after the procedure were 85%, 77%,and 62% in the navigation group, and 54%, 40%, and 35% in the control. Recurrences in the control group were more common than that in the navigation group. Annual recurrence rate in the first and second years were 15% and 23% in the navigation group, and 46%, 60% in the control group. No side-effect and complication was noted in the navigation group except minimal facial hypesthesia.Conclusion Neuronavigator-guided PRTTG is a safe and promising method for treatment of intractable TN with better short- and long-term outcomes and lower complication rate than PRTTG without neuronavigation.

  3. Percutaneous radiofrequency ablation of renal cell cancer; Perkutane Radiofrequenzablation von Nierentumoren

    Energy Technology Data Exchange (ETDEWEB)

    Tacke, J.; Mahnken, A.H. [Klinik fuer Radiologische Diagnostik, Universitaetsklinikum Aachen (Germany)

    2004-04-01

    Renal cell cancer is the most frequent malignant tumor of the kidney. Depending on tumor size, extension and general condition, radical or partial nephrectomy, which meanwhile can be performed laparoscopically, is still the therapy of choice. Patients with an increased surgical risk, or suffering from additional renal tumors or tumor in a single kidney, percutaneous tumor ablation is a helpful therapeutical option. Among all thermal ablation procedures, most experiences exist with radiofrequency ablation (RFA). A significant advantage of this technique is the possibility of direct puncture of the tumor without Seldinger technique and track ablation. This helps to reduce the risk of bleeding and tumor seeding within the puncture track. By use of modern ablation probes, lesions of up to 5 cm diameter can be created without repositioning of the probe. Initial superselective particle embolization is recommended in tumors beyond 3 cm in size, because renal cell cancer is often hypervascularized and devasularization helps to reduce ablation time. Furthermore, the tumor location within the kidney is influencing the ablation result. Exophytically growing lesions or tumors within the renal parenchyma can be treated with a safety margin. Tumors in a central location or with broad contact to the collecting system are no candidates for thermal ablation, because of an increased risk of thermal collateral damage. Computed tomography is an optimal imaging modality and crucial to planning, performing and controlling of a successful percutaneous RFA. Based on the previous experiences of 300 published cases, renal RFA results in an over 90% success rate associated with a low complication rate. A randomized controlled study comparing RFA and surgery is necessary to answer the question whether RFA can be considered therapy of first choice even for patients, who are according to the actual evidence surgical candidates. (orig.) [German] Das Nierenzellkarzinom ist der haeufigste maligne

  4. Radiofrequency ablation of a misdiagnosed Brodie's abscess.

    Science.gov (United States)

    Chan, Rs; Abdullah, Bjj; Aik, S; Tok, Ch

    2011-04-01

    Radiofrequency ablation (RFA) therapy is recognised as a safe and effective treatment option for osteoid osteoma. This case report describes a 27-year-old man who underwent computed tomography (CT)-guided percutaneous RFA for a femoral osteoid osteoma, which was diagnosed based on his clinical presentation and CT findings. The patient developed worsening symptoms complicated by osteomyelitis after the procedure. His clinical progression and subsequent MRI findings had led to a revised diagnosis of a Brodie's abscess, which was further supported by the eventual resolution of his symptoms following a combination of antibiotics treatment and surgical irrigations. This case report illustrates the unusual MRI features of osteomyelitis mimicking soft tissue tumours following RFA of a misdiagnosed Brodie's abscess and highlights the importance of a confirmatory histopathological diagnosis for an osteoid osteoma prior to treatment.

  5. Role of percutaneous ultrasonographic guided radiofrequency ablation in the management of hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Mohamed Ahmed Youssef

    2014-06-01

    Conclusion: Radiofrequency thermal ablation is a simple, effective and less expensive technique with a low morbidity compared with surgical treatment. Radiofrequency thermal ablation can produce significant long-term survival rates and excellent local control for cirrhotic patients with early stage, unresectable HCC.

  6. Percutaneous radiofrequency ablation of osteoid osteomas with use of real-time needle guidance for accurate needle placement: a pilot study

    NARCIS (Netherlands)

    Busser, W.M.H.; Hoogeveen, Y.L.; Veth, R.P.H.; Schreuder, H.W.B.; Balguid, A.; Renema, W.K.J.; Schultze Kool, L.J.

    2011-01-01

    PURPOSE: To evaluate the accuracy and technical success of positioning a radiofrequency ablation (RFA) electrode in osteoid osteomas by use of a new real-time needle guidance technology combining cone-beam computed tomography (CT) and fluoroscopy. MATERIALS AND METHODS: Percutaneous RFA of osteoid

  7. Percutaneous T2 and T3 Radiofrequency Sympathectomy for Complex Regional Pain Syndrome Secondary to Brachial Plexus Injury: A Case Series

    Science.gov (United States)

    Phui, Vui Eng; Nizar, Abd Jalil; Yeo, Sow Nam

    2013-01-01

    Complex regional pain syndrome secondary to brachial plexus injury is often severe, debilitating and difficult to manage. Percuteneous radiofrequency sympathectomy is a relatively new technique, which has shown promising results in various chronic pain disorders. We present four consecutive patients with complex regional pain syndrome secondary to brachial plexus injury for more than 6 months duration, who had undergone percutaneous T2 and T3 radiofrequency sympathectomy after a diagnostic block. All four patients experienced minimal pain relief with conservative treatment and stellate ganglion blockade. An acceptable 6 month pain relief was achieved in all 4 patients where pain score remained less than 50% than that of initial score and all oral analgesics were able to be tapered down. There were no complications attributed to this procedure were reported. From this case series, percutaneous T2 and T3 radiofrequency sympathectomy might play a significant role in multi-modal approach of CRPS management. PMID:24156009

  8. Long - term Efficacy and Safety of CT Guided Sphenopalatine Ganglion Radiofrequency Thermocoagulation in the Treatment of Sphenopalatine Neuralgia%CT 引导下蝶腭神经节射频热凝术治疗蝶腭神经痛的长期疗效及安全性分析

    Institute of Scientific and Technical Information of China (English)

    李娜; 郭玉娜; 秦红军; 贾绍芳; 左欣鹭; 杨惠婕; 倪家骧

    2016-01-01

    radiofrequency thermocoagulation in the treatment of sphenopalatine neuralgia( SPN). Methods The study enrolled 8 SPN patients who received CT guided sphenopalatine ganglion radiofrequency thermocoagulation in the Department of Pain Management,Xuanwu Hospital Capital Medical University from October 2005 to May 2014. Telephone follow - up was conducted on patients from October 2005 to December 2015,lasting for 19 - 122 months with(55. 4 ± 12. 8)months on average. NRS and VAS of patients before surgery were recorded,and NRS,VAS and pain relief status were recorded 3 days,1 month,3 months, 6 months,1 year,2 years,3 years,5 years,7 years and 10 years after surgery,and postoperative reactions were observed (including visual impairment,facial hematoma,intracranial infection,postural hypotension and syncope). Results The 3 days pain relief rate was 100. 0% after surgery. All the patients completed follow - up,and 1 month,3 months,6 months,1 year,3 years,5 years,7 years and 10 years pain relief rates were all 100. 0% after surgery;2 years pain relief rate was 87. 5%after surgery;one(12. 5% )patient who had relapse 16 months after surgery had pain controlled after the oral administration of tramadol hydrochloride sustained - release tablets and prepared to take CT guided sphenopalatine ganglion radiofrequency thermocoagulation again. Before surgery,the NRS and VAS of the 8 patients were(8. 4 ± 1. 4)and 0;3 days after surgery,the NRS and VAS of the 8 patients were(0. 3 ± 0. 7)and(2. 6 ± 5. 6);1 month,3 months,6 months and 12 months after surgery,the VAS was(1. 5 ± 1. 3),(1. 1 ± 1. 1),(0. 5 ± 0. 9) and 0 respectively and the NRS was all 0;2 years after surgery,the NRS and VAS of 6 patients were both 0;3 years and 5 years after surgery,the NRS of 4 patients was 0 and(0. 5 ± 1. 0 )respectively,and VAS was all 0;7 years after surgery,NRS and VAS of 2 patients were both 0;10 years after surgery,the NRS and VAS of 1 patient were 2 and 0 respectively. After surgery,patients did not have

  9. Percutaneous ethanol injection, radiofrequency and their combination in treatment of hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Bao-Ming Luo; Yan-Ling Wen; Hai-Yun Yang; Hui Zhi; Xiao-Yun Xiao; Bing Ou; Jing-Sheng Pan; Jian-Hong Ma

    2005-01-01

    AIM: To evaluate the therapeutic effect and the indication of percutaneous ethanol injection (PEI),radiofrequency ablation (RFA) and their combination in treatment of hepatocellular carcinoma (HCC).METHODS: Two hundred and fifty-five patients with HCC received treatment of PEI, RFA or their combination.Group1 (< 3 cm in diameter, n=85) was treated with PEI,group2 (< 3 cm in diameter, n=153) with RFA. Group3(>3 cm in diameter, n=86) was divided into two groups.Group 3a (n=34) was treated with RFA, while group 3b(n=52) was treated with RFA for 2 wk after transcatheter arterial chemoembolization or PEI. Contrast-enhanced sonography was performed for 61 patients before and after RFA. Liver function and serum alpha-fetoprotein (AFP) were measured for all patients. Changes of the lesions on ultrasound and contrast-enhanced CT/MRI were evaluated for assessing the therapeutic responses.The 1-, 2-, 3- and 5-year survival rates were recorded after treatment.RESULTS: In group 1, the complete necrosis rate of lesions after 1 mo was 77.6% (66/85). The level of AFP declined conspicuously after 1 mo. The 1-, 2-, 3- and 5-year survival rate after treatment was 80.0% (52/65),60.4% (32/53), 52.5% (21/40) and 33.3% (7/21),respectively. In group 2, the complete necrosis rate of lesions after 1 moh was 92.2% (141/153). The level of AFP decreased conspicuously after 1 mo. The 1-, 2-,3- and 5-year survival rate after treatment was 94.6%(88/93), 73.2% (52/71), 63.5% (33/52) and 46.4%(13/28), respectively. In group 3a, the complete necrosis rate of lesions after 1 mo was 23.5% (8/34). AFP dropped down to the normal level in only one patient after 1 mo. The 1-, 2- and 3-year survival rate after treatment was 47.6% (10/21), 42.9% (6/14) and 27.3%(3/11), respectively. Only one patient was still alive after 5 years. In group 3b, the complete necrosis rate of lesions after 1 mo was 57.7% (30/52). The level of AFP decreased after 1 mo. The 1-, 2-, 3- and 5-year survival rate after

  10. Percutaneous bipolar radiofrequency thermocoagulation for the treatment of lumbar disc herniation.

    Science.gov (United States)

    Zeng, Zhenhua; Yan, Min; Dai, Yi; Qiu, Weidong; Deng, Shuo; Gu, Xinzhu

    2016-08-01

    Lumbar disc herniation is usually managed with conservative treatment or surgery. However, conservative therapy seldom yields good results, and surgery is associated with multiple complications. This study aimed to assess bipolar radiofrequency thermocoagulation for the treatment of lumbar disc herniation. A total of 168 patients with lumbar disc herniation suitable for radiofrequency thermocoagulation were enrolled and randomized to monopolar radiofrequency thermocoagulation (control group, n=84) or bipolar radiofrequency thermocoagulation (experimental group, n=84) treatment groups. Ablation sites were targeted under CT scan guidance, and consecutive radiofrequency therapy was used. One and two probes were used for monopolar and bipolar thermocoagulation, respectively. Thermocoagulation was achieved at 50°C, 60°C, and 70°C for 60s each, 80°C for 90s, and 92°C for 100s. Symptoms and complications were evaluated using the modified Macnab criteria and Visual Analog Scale at 7, 30, and 180days postoperatively. At 180days, a significantly higher efficacy rate was obtained in the experimental group compared with control patients (91.6% versus 79.7%, Plumbar disc herniation treatment, and should be further explored for broad clinical application.

  11. Percutaneous Intraductal Radiofrequency Ablation for Clearance of Occluded Metal Stent in Malignant Biliary Obstruction: Feasibility and Early Results

    Energy Technology Data Exchange (ETDEWEB)

    Pai, Madhava, E-mail: madhava.pai@imperial.ac.uk [Hammersmith Hospital, Imperial College, HPB Unit, Department of Surgery (United Kingdom); Valek, Vlastimil; Tomas, Andrasina [University Hospital Brno Bohunice, Department of Radiology (Czech Republic); Doros, Attila [Semmelweis University, Radiology Unit, Department of Transplantation and Surgery (Hungary); Quaretti, Pietro [IRCCS Policlinico San Matteo, Department of Radiology (Italy); Golfieri, Rita; Mosconi, Cristina [University of Bologna, Department of Radiology, Policlinico S. Orsola-Malpighi (Italy); Habib, Nagy, E-mail: nagy.habib@imperial.ac.uk [Hammersmith Hospital, Imperial College, HPB Unit, Department of Surgery (United Kingdom)

    2013-07-11

    PurposeThe major complication occurring with biliary stents is stent occlusion, frequently seen because of tumour in-growth, epithelial hyperplasia, and sludge deposits, resulting in recurrent jaundice and cholangitis. We report a prospective study with the results of first in man percutaneous intraductal radiofrequency (RF) ablation to clear the blocked metal stents in patients with malignant biliary obstruction using a novel bipolar RF catheter.MethodsNine patients with malignant biliary obstruction and blocked metal stents were included. These patients underwent intraductal biliary RF ablation through the blocked metal stent following external biliary decompression with an internal–external biliary drainage.ResultsAll nine patients had their stent patency restored successfully without the use of secondary stents. Following this intervention, there was no 30-day mortality, haemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the nine patients, six are alive and three patients are dead with a median follow-up of 122 (range 50–488) days and a median stent patency of 102.5 (range 50–321) days. Six patients had their stent patent at the time of last follow-up or death. Three patients with stent blockage at 321, 290, and 65 days postprocedure underwent percutaneous transhepatic drain insertion and repeat ablation.ConclusionsIn this selective group of patients, it appears that this new approach is safe and feasible. Efficacy remains to be proven in future, randomized, prospective studies.

  12. Intraoperative radiofrequency ablation with or without tumorectomy for hepatocellular carcinoma in locations dif ifcult for a percutaneous approach

    Institute of Scientific and Technical Information of China (English)

    Hyung Ook Kim; Seung Kwon Kim; Byung Ho Son; Chang Hak Yoo; Hyun Pyo Hong; Yong Kyun Cho; Byung Ik Kim

    2009-01-01

    BACKGROUND: Although hepatic resection is widely accepted as a proper modality for treating hepatocellular carcinoma (HCC), a majority of patients are unable to undergo surgical resection due to various tumor and patient factors. Radiofrequency ablation (RFA) has mostly been used as a therapeutic alternative to resection for treating HCC. The objective of this study was to evaluate the results of intraoperative RFA for HCCs in locations dififcult for a percutaneous approach. METHODS: Eight patients (male, seven;age, 49-67 years) with 8 HCCs in dififcult locations were treated by intraoperative RFA. Six of the patients had local tumor progression after initial transarterial chemoembolization or ultrasound (US) guided percutaneous RFA. The locations of the tumors were hepatic dome in six patients, posterior subcapsule in one, and caudate lobe in one. The tumor size was 2.0 to 6.4 cm (mean, 3.9 cm). Intraoperative RFA was performed at the tumor itself and an anticipated resection line under US guidance with 3 cm monopolar single or clustered internally cooled electrodes. Tumor resection was performed in six patients. One month later, treatment response was assessed by contrast material-enhanced computed tomography (CT). CT studies were performed every 2 or 3 months after RFA. RESULTS: RFA was technically successful in all tumors, and the contrast-enhanced CT images acquired one month later showed complete disappearance of tumor enhancement. One pneumothorax occurred. After a median follow-up of 18 months (range, 6-30 months), no tumors showed local progression. During the follow-up period, four new recurrent tumors were observed in three patients. Four patients were alive at the time of this report and the other four died of hepatorenal syndrome, liver failure, and progression of new recurrent tumors. CONCLUSION: Intraoperative RFA with tumor resection can be an alterative treatment option for HCC in locations dififcult for a percutaneous approach.

  13. Clinical study of ultrasound-guided percutaneous radiofrequency ablation for primary hepatic carcinoma adjacent to the diaphragm

    Directory of Open Access Journals (Sweden)

    LI Meng

    2015-04-01

    Full Text Available ObjectiveTo investigate the safety and efficacy of ultrasound (US-guided percutaneous radiofrequency ablation (RFA for primary hepatic carcinoma adjacent to the diaphragm. MethodsThis study included 277 patients with 362 lesions of primary hepatic carcinoma managed with US-guided percutaneous RFA in 302 Hospital of PLA from January 2011 to October 2014. Sixty-six patients with 71 hepatocellular carcinomas (HCCs located less than 5 mm from the diaphragm were in study group, and 95 patients with 114 HCCs located more than 10 mm from the hepatic surface were in control group. The patients′ symptoms and complications were observed after the therapy. The complete ablation rate, local tumor progression rate, and complication rate were compared between the two groups. Comparison of continuous data between the two groups was made by independent-samples t test, while comparison of categorical data was made by chi-square test. ResultsAt one month after operation, 65 (91.5% of 71 tumors in the study group and 107 (93.9% of 114 tumors in the control group achieved complete ablation, according to contrast-enhanced CT and MRI, and there was no significant difference between the two groups (χ2=0.36, P=0.55. The postoperative follow-up showed that the local tumor progression rates in the study group and control group were 16.9% and 13.2%, respectively, without significant difference between the two groups (χ2=0.49, P=0.48. In the study group, 22 patients developed adverse reactions, versus 37 patients in the control group (χ2=2.60, P=0.11. ConclusionUS-guided percutaneous RFA is a safe and effective means for the treatment of primary hepatic carcinoma adjacent to the diaphragm.

  14. Outcome of long-axis percutaneous sacroplasty for the treatment of sacral insufficiency fractures with a radiofrequency-induced, high-viscosity bone cement

    Energy Technology Data Exchange (ETDEWEB)

    Eichler, Katrin [University of Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); J. W. Goethe University of Frankfurt, Institute for Diagnostic and Interventional Radiology, Frankfurt (Germany); Zangos, Stephan; Vogl, Thomas J. [University of Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Mack, Martin G. [Radiology Munich, Munich (Germany); Marzi, Ingo [University of Frankfurt, Department of Trauma, Hand and Reconstructive Surgery, Frankfurt (Germany)

    2014-04-15

    Our goal was to assess the technical results in patients who underwent long-axis sacroplasty for the treatment of sacral insufficiency fractures (SIF) by radiofrequency-induced high-viscosity bone cement augmentation. Twelve patients with bilateral sacral fractures were treated by augmentation with radiofrequency-activated, high-viscosity polymethylmethacrylate (PMMA) bone cement under local anesthesia. CT-guided sacroplasty was performed by using a long-axis approach through a single entry point. Thirty-six vertebrae were treated in 12 sessions under a combination of CT and fluoroscopic guidance using a bilateral access and a cavity-creating osteotome prior to remote-controlled, hydraulically driven cement injection. The visual analogue scale (VAS) score before sacroplasty and at 1 and 3 months after the treatment was obtained. PMMA leaks were evaluated retrospectively using the post-interventional CT. The mean amount of high-viscosity PMMA injected per patient was 7.8 ml. No major adverse events were observed. In the first 4 days after the procedure, the mean VAS score decreased from 8.1 ± 1.9 to mean 3.1 ± 1.2 and was followed by a gradual but continuous decrease throughout the rest of the follow-up period at 24 weeks (mean 2.2 ± 1.1) and 48 weeks (mean 2.1 ± 1.4). CT fluoroscopy-guided sacral augmentation was safe and effective in all 12 patients with osteoporotic SIF. (orig.)

  15. CT Guided Laser Ablation of Osteoid Osteoma

    Directory of Open Access Journals (Sweden)

    Manohar Kachare

    2015-10-01

    Full Text Available To present our experience of Computed Tomography (CT guided laser ablation of radiologically proven osteoid osteoma in the inter trochantric region of the femur. A19 year old female presented with severe pain in left upper thigh region since 6-7 months, which was exaggerated during nights and was relived on taking oral Non Steroid Anti Inflammatory Drugs (NSAIDs. On CT scan hypodense lesion with surrounding dense sclerosis noted in intertrochanteric region in left femur. Magnetic Resonance Imaging (MRI revealed small focal predominantly cortical, oval lytic lesion in the intertrochanteric region which appeared hypointense on T1 Weighted Image (T1WI and hyperintense on T2 Weighted Image (T2WI and Short Tau Inversion Recovery (STIR image. Diffuse extensive sclerosis and hyperostosis of bone was noted surrounding the lesion appearing hypointense on T1W and T2W images. Under local anesthesia the laser fibre was inserted in the nidus under CT guidance through bone biopsy needle and 1800 joules energy delivered in the lesion continuous mode. Complete relief of pain noted after 24 hours after the treatment. CT guided LASER ablation is a safe, simple and effective method of treatment for osteoid osteoma.

  16. Radiofrequency Ablation for 110 Malignant Liver Tumours: Preliminary Results on Percutaneous and Surgical Approaches

    Directory of Open Access Journals (Sweden)

    J. Wong

    2009-01-01

    Conclusion: RFA is a safe and effective procedure for treating patients with malignant liver tumours. No difference in short term outcomes was observed between percutaneous and surgical approaches. A more prolonged follow-up study is required to assess longer-term outcomes.

  17. Percutaneous Management of a Bronchobiliary Fistula after Radiofrequency Ablation in a Patient with Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Dok Hyun; Shim, Ju Hyun; Lee, Wook Jin; Kim, Pyo Nyun; Shin, Ji Hoon; Kim, Kang Mo [Asan Medical Center, Seoul (Korea, Republic of)

    2009-08-15

    Radiofrequency ablation (RFA) is a minimally invasive, image-guided procedure for the treatment of hepatic tumors. While RFA is associated with relatively low morbidity, sporadic bronchobiliary fistulae due to thermal damage may occur after RFA, although the incidence is rare. We describe a patient with a bronchobiliary fistula complicated by a liver abscess that occurred after RFA. This fistula was obliterated after placement of an external drainage catheter into the liver abscess for eight weeks.

  18. The establishment of animal models with secondary hypersplenism by using percutaneous embolism of splenic vein technique and the study on radiofrequency ablation%经皮穿刺脾静脉栓塞建立继发性脾功能亢进的动物模型和射频消融治疗研究

    Institute of Scientific and Technical Information of China (English)

    王素; 赵卫; 胡继红; 易根发; 王滔

    2014-01-01

    Objective To introduce a method for fast establishment of pig models with secondary hypersplenism, and using this model to study the effect of radiofrequency ablation (RFA). Methods Congestive splenomegaly was created by CT- guided percutaneous embolization of splenic vein and its collateral branches in pigs. Then radiofrequency ablation was employed in the models to observe the changes of peripheral blood as well as the spleen changes in its morphology and histopathology. The blood cell count for peripheral venous blood was determined once a week, and the spleen size was measured by CT scanning. Results One week after splenic vein embolization, the counts of peripheral erythrocytes and platelets showed a reduction, which became more obvious in three weeks (P < 0.05). Erythropenia, thrombocytopenia and splenomegaly could last for over six weeks. At the second week after the procedure , pathologically the spleen assumed passive congestion appearance. The thermal energy produced by radiofrequency ablation could cause local splenic coagulation necrosis, splenic vessels occlusion and splenic thrombotic infarction due to diffuse micro-vascular thrombosis. Conclusion To establish an animal model with secondary hypersplenism, the method of CT-guided percutaneous embolism of splenic vein is simple and reliable. The animal models can be used for surgical or interventional researches. Radiofrequency ablation is an effective intervention means.%目的:介绍一种快速建立的继发性脾功能亢进(脾亢)的猪动物模型,并在此模型基础上进行射频消融治疗(RFA)研究。方法在B型超声或CT导向下经皮穿刺猪脾静脉主干并栓塞引起淤血性脾肿大,再进行RFA治疗,观察动物外周血细胞变化,了解脾脏影像学变化以及组织病理学改变。结果脾静脉栓塞后1周外周血红细胞、血小板即下降,第3周以后二者下降明显(P<0.05),红细胞和血小板减少,脾肿大可持续6

  19. Accuracy and efficacy of percutaneous biopsy and ablation using robotic assistance under computed tomography guidance: a phantom study

    Energy Technology Data Exchange (ETDEWEB)

    Koethe, Yilun [National Institutes of Health, Center for Interventional Oncology, NIH Clinical Center, Bethesda, MD (United States); National Institutes of Health, Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, MD (United States); Duke University School of Medicine, Durham, NC (United States); Xu, Sheng [National Institutes of Health, Center for Interventional Oncology, NIH Clinical Center, Bethesda, MD (United States); Velusamy, Gnanasekar [Perfint Healthcare Pvt. Ltd., Chennai (India); Wood, Bradford J. [National Institutes of Health, Center for Interventional Oncology, NIH Clinical Center, Bethesda, MD (United States); National Institutes of Health, Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, MD (United States); Venkatesan, Aradhana M. [National Institutes of Health, Center for Interventional Oncology, NIH Clinical Center, Bethesda, MD (United States); National Institutes of Health, Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, MD (United States); National Institutes of Health, Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, MD (United States)

    2014-03-15

    To compare the accuracy of a robotic interventional radiologist (IR) assistance platform with a standard freehand technique for computed-tomography (CT)-guided biopsy and simulated radiofrequency ablation (RFA). The accuracy of freehand single-pass needle insertions into abdominal phantoms was compared with insertions facilitated with the use of a robotic assistance platform (n = 20 each). Post-procedural CTs were analysed for needle placement error. Percutaneous RFA was simulated by sequentially placing five 17-gauge needle introducers into 5-cm diameter masses (n = 5) embedded within an abdominal phantom. Simulated ablations were planned based on pre-procedural CT, before multi-probe placement was executed freehand. Multi-probe placement was then performed on the same 5-cm mass using the ablation planning software and robotic assistance. Post-procedural CTs were analysed to determine the percentage of untreated residual target. Mean needle tip-to-target errors were reduced with use of the IR assistance platform (both P < 0.0001). Reduced percentage residual tumour was observed with treatment planning (P = 0.02). Improved needle accuracy and optimised probe geometry are observed during simulated CT-guided biopsy and percutaneous ablation with use of a robotic IR assistance platform. This technology may be useful for clinical CT-guided biopsy and RFA, when accuracy may have an impact on outcome. (orig.)

  20. Is Antibiotic Prophylaxis for Percutaneous Radiofrequency Ablation (RFA) of Primary Liver Tumors Necessary? Results From a Single-Center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Bhatia, Shivank S., E-mail: sbhatia1@med.miami.edu [University of Miami, Vascular/Interventional Radiology, Department of Radiology, Miller School of Medicine (United States); Spector, Seth, E-mail: sspector@med.miami.edu [University of Miami, Department of Surgery, VA Hospital (Veterans Affairs Medical Center) (United States); Echenique, Ana, E-mail: aechenique@med.miami.edu; Froud, Tatiana, E-mail: tfroud@med.miami.edu; Suthar, Rekha, E-mail: rsuthar@med.miami.edu; Lawson, Ivy, E-mail: i.lawson1@med.miami.edu; Dalal, Ravi, E-mail: rdalal@med.miami.edu [University of Miami, Vascular/Interventional Radiology, Department of Radiology, Miller School of Medicine (United States); Dinh, Vy, E-mail: vdinh@med.miami.edu [VA Hospital (Veterans Affairs Medical Center), Department of Medicine (United States); Yrizarry, Jose, E-mail: jyrizarr@med.miami.edu; Narayanan, Govindarajan, E-mail: gnarayanan@med.miami.edu [University of Miami, Vascular/Interventional Radiology, Department of Radiology, Miller School of Medicine (United States)

    2015-08-15

    PurposeThe purpose of this study was to evaluate need for antibiotic prophylaxis for radiofrequency ablation (RFA) of liver tumors in patients with no significant co-existing risk factors for infection.Materials and MethodsFrom January 2004 to September 2013, 83 patients underwent 123 percutaneous RFA procedures for total of 152 hepatocellular carcinoma (HCC) lesions. None of the patients had pre-existing biliary enteric anastomosis (BEA) or any biliary tract abnormality predisposing to ascending biliary infection or uncontrolled diabetes mellitus. No pre- or post-procedure antibiotic prophylaxis was provided for 121 procedures. Data for potential risk factors were reviewed retrospectively and analyzed for the frequency of infectious complications, including abscess formation.ResultsOne patient (1/121 (0.8 %) RFA sessions) developed a large segment 5 liver abscess/infected biloma communicating with the gallbladder 7 weeks after the procedure, successfully treated over 10 weeks with IV and PO antibiotic therapy and percutaneous catheter drainage. This patient did not receive any antibiotics prior to RFA. During the procedure, there was inadvertent placement of RFA probe tines into the gallbladder. No other infectious complications were documented.ConclusionThese data suggest that the routine use of prophylactic antibiotics for liver RFA is not necessary in majority of the patients undergoing liver ablation for HCC and could be limited to patients with high-risk factors such as the presence of BEA or other biliary abnormalities, uncontrolled diabetes mellitus, and large centrally located tumors in close proximity to central bile ducts. Larger randomized studies are needed to confirm this hypothesis.

  1. CT-guided percutaneous irreversible electroporation for the treatment of locally advanced pancreatic cancer%CT引导不可逆电穿孔消融术治疗局部晚期胰腺癌的有效性和安全性

    Institute of Scientific and Technical Information of China (English)

    魏颖恬; 肖越勇; 张肖; 何晓锋; 张欣; 李婕; 杨杰; 张啸波

    2016-01-01

    目的:评价CT引导不可逆电穿孔(IRE)消融术治疗局部晚期胰腺癌的有效性和安全性。方法前瞻性收集经穿刺病理证实的影像表现提示为Ⅲ期胰腺癌患者14例,术前常规行实验室检查和影像检查(CT、MRI、PET-CT等)了解患者的疾病状况。在全身麻醉下行IRE消融术,于CT引导下经皮穿刺置入消融电极,根据肿瘤大小、位置及电极针数目进行消融参数设置,电极针尖端裸露1 cm,消融模式为拔针分段消融。术后第1~3天、1周、1.0个月、3.0个月复查影像及实验室检查,采用改良的WHO实体瘤疗效评价标准评价IRE消融治疗的有效性。观察并发症发生情况。结果14例患者手术均顺利完成。消融完成后即刻行CT增强扫描,消融区均呈低密度坏死改变,无强化,消融边界清晰。术后1周复查CT,14例肿瘤坏死彻底,周围组织结构无破坏。术后1.0个月行CT或MRI显示所有病灶消融区域均呈低密度(信号)改变,增强扫描未见异常强化,周围血管及胰管形态完整。术后胰淀粉酶及CA199一过性升高,而后逐渐降低,术后1周及1.0个月后复查明显降低,癌胚抗原未见明显升高。并发症包括胰周炎性渗出3例、腹膜后感染1例、肠系膜上静脉血栓2例、门静脉主干血栓2例、十二指肠狭窄1例。1例术后2.5个月死于消化道大出血。其余13例于术后3个月评价疗效,完全缓解4例、部分缓解7例、病变稳定2例。结论 CT引导下IRE消融术治疗局部晚期胰腺癌有效、安全。%Objective To investigate the safety and efficacy of treatment with CT-guided percutaneous irreversible electroporation (IRE) of locally advanced pancreatic cancer(LAPC). Methods Patients with unresectable radiographic stage ⅢLAPC were prospectively collected. Comprehensive blood and imaging (CT,MRI,PET-CT) baseline examinations were completed and analyzed preoperatively

  2. Radiofrequency ablation of a misdiagnosed Brodie’s abscess

    Science.gov (United States)

    Chan, RS; Abdullah, BJJ; Aik, S; Tok, CH

    2011-01-01

    Radiofrequency ablation (RFA) therapy is recognised as a safe and effective treatment option for osteoid osteoma. This case report describes a 27-year-old man who underwent computed tomography (CT)-guided percutaneous RFA for a femoral osteoid osteoma, which was diagnosed based on his clinical presentation and CT findings. The patient developed worsening symptoms complicated by osteomyelitis after the procedure. His clinical progression and subsequent MRI findings had led to a revised diagnosis of a Brodie’s abscess, which was further supported by the eventual resolution of his symptoms following a combination of antibiotics treatment and surgical irrigations. This case report illustrates the unusual MRI features of osteomyelitis mimicking soft tissue tumours following RFA of a misdiagnosed Brodie’s abscess and highlights the importance of a confirmatory histopathological diagnosis for an osteoid osteoma prior to treatment. PMID:22291860

  3. Therapeutic comparison between radiofrequency ablation and percutaneous ethanol injection in treatment of primary liver cancer: a meta-analysis

    Directory of Open Access Journals (Sweden)

    YIN Yu

    2015-06-01

    Full Text Available ObjectiveTo compare the efficacy of radiofrequency ablation (RFA versus percutaneous ethanol injection (PEI in the treatment of primary liver cancer(PLC. MethodsA search of PubMed, EMBASE, CKNI, VIP, and Wanfang Data identified all randomized controlled trials (RCTs related to therapeutic comparison between RFA and PEI in patients with PLC. Quality of each study was assessed, meta-analysis was performed with Review Manager 5.0 software, and the results were analyzed with fixed effect model and random effect model. ResultsSeven RCTs were included in this study. The results of meta-analysis indicated that, compared with the PEI group, the RFA group had a significantly higher tumor necrosis rate (P=0.008, OR=2.66, 95%CI: 1.29-5.48. The 1-, 2-, and 3-year survival rates and 1- and 3-year tumor-free survival rates of the RFA group were significantly higher than those of the PEI group (P<005. The RFA group had significantly lower 1-, 2-, and 3-year local recurrence rates in comparison with the PEI group (P<005. There was no significant difference in 2-year tumor-free survival rate between the two groups (P=0.06. ConclusionThe efficacy of RFA is superior to that of PEI, which is of clinical significance to guide the selection of methods for PLC treatment.

  4. Comparison of the Efficacy of Reoperation, Percutaneous Radiofrequency Thermocoagulation When Microvascular Decompression of Trigeminal Neuralgia Is Invalid.

    Science.gov (United States)

    Zhang, Xin; Zhao, Hua; Tang, Yinda; Zhu, Jin; Wang, Xuhui; Li, Shiting

    2016-10-01

    To compare the curative effect of reoperation in short-term and percutaneous radiofrequency thermocoagulation (PRT) when trigeminal neuralgia patient after microvascular decompression (MVD) is invalid. Follow-up of 54 patients (30 patients with reoperation in the short term, 24 patients with PRT of primitive trigeminal neuralgia) when MVD is invalid between January 2008 and December 2014. To evaluate the degree of pain relief and facial numbness of patients after the treatment in short-term (1 month), in long-term (1 year). One month after surgery, the authors compared the reoperation group with PRT group. The ratio of cure rate P = 0.02, the ratio of effective rate P = 0.04, the ratio of facial numbness P = 0.01; 1 year after surgery, the authors compared the reoperation group with PRT group. The ratio of cure rate P = 0.004, the ratio of effective rate P = 0.006, the ratio of facial numbness P = 0.02, the ratio of recurrence P = 0.04. The short-term and long-term clinical efficacy in reoperation group was better than PRT group (P neuralgia when first MVD is invalid, reoperation is better than PRT, and a significantly lower incidence of facial numbness and recurrence than PRT.

  5. Feasibility study on CT guided percutaneous incisional needle biopsy for deep pelvic masses by different puncture approaches%CT导向盆腔深部肿块穿刺切割活检术不同穿刺路径的可行性探讨

    Institute of Scientific and Technical Information of China (English)

    郑家平; 邵国良; 陈玉堂; 樊树峰; 杨建民

    2009-01-01

    Objective To explore the feasibility of CT guided pereutaneous incisional needle biopsy (PINB) for deep pelvic masses at different locations via various puncture approaches.Methods PINBs under CT guidance were performed in 70 patients with 72 pelvic lesions through different puncture approaches.Their pathological findings and safety were evaluated after follow-up of a period of 1-34 months.Results PINBs were performed through transpiriform-muscle in 27 cases,16 through transgluteal approach,5 through posterior oblique approach in prone position,8 by anterior or lateral transabdominal route,8 through iliopsoas muscle and 8 by direct transosseous approach,respectively.Sixty-four malignant lesions were confirmed by pathology,including 30 adenocarcinomas,19 squamous cell carcinomas,5 unclassified malignant tumors,3 small cell carcinomas,2 malignant giant cell tumors of bone,2 hepatocellular carcinomas and 3 false negative lesions which were confirmed at the second PINBs as malignant tumors,respectively.Benign neoplasms were confirmed in 8 cases,including fibrosis tissue in 6 lesions,bone tuberculosis in 1 and ovarian cyst in 1.The sensitivity,specificity,and accuracy rate were 95.3% (61/64),100% (8/8),and 95.8% (69/72),respectively.Twenty-two cases via transpiriform-muscle approach suffered from transient deep pelvic pain which radiated to the lower limbs of the same side.No hematoma,nerve damage,infection,and tumor transplantation in pelvic cavity developed after the PINB procedure.Conclusion CT guided percutaneous incisional needle biopsy through different puncture approaches is safe and feasible for the patients with deep masses at different locations in the pelvic cavity.%目的 探讨根据盆腔深部肿块位置不同,设计相应穿刺路径进行CT导向下经皮穿刺切割活检术(PINB)的可行性.方法 70例患者的72个盆腔新发肿块,根据肿块部位以及肿块与周围组织脏器的关系,以避开重要脏器、组织为原则,采取不同

  6. Percutaneous radiofrequency ablation for lung tumors beneath the rib under CT fluoroscopic guidance with gantry tilt

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Takanobu; Yamagami, Takuji; Tanaka, Osamu; Yoshimatsu, Rika; Miura, Hiroshi; Nishimura, Tsunehiko (Dept. of Radiology, Graduate School of Medical Science, Kyoto Prefectural Univ. of Medicine, Kamigyo, Kyoto (Japan)), e-mail: yamagami@koto.kpu-m.ac.jp

    2010-05-15

    Background: Radiofrequency (RF) ablation of lung tumors has become a treatment of choice, especially for unresectable cases. However, RF ablation of small lung lesions located just beneath the rib is difficult. Purpose: To evaluate the efficacy and safety of gantry tilting for the performance of RF ablation of peripheral lesions located beneath the rib. Material and Methods: Our study was based on 18 of 293 lesions in the lung for which RF ablation was performed under CT scan fluoroscopic guidance at our institution between October 2004 and March 2009. For these 18 lesions, RF ablation was performed with gantry tilting because a rib blocked visualization of the RF ablation route even after other attempts had been made to change the relationship between the target and the rib. Results: All RF needles, with only one exception, were successfully advanced to hit the tumor. The commonest complication was a pneumothorax, which occurred in seven procedures. No serious complications occurred. The progression-free rates were 82.4% at 6 months, 62.5% at 12 months, and 30% at 24 months. Mean local progression-free duration was 17.6+-11.6 months (range 4-36 months). Conclusion: RF ablation under CT scan fluoroscopic guidance with gantry tilt is a useful and safe technique for RF ablation of lung nodules located beneath the rib

  7. Percutaneous Renal Tumor Ablation: Radiation Exposure During Cryoablation and Radiofrequency Ablation

    Energy Technology Data Exchange (ETDEWEB)

    McEachen, James C., E-mail: james.mceachen2@gmail.com [Mayo Clinic, Division of Preventive, Occupational, and Aerospace Medicine (United States); Leng, Shuai; Atwell, Thomas D. [Mayo Clinic, Department of Radiology (United States); Tollefson, Matthew K. [Mayo Clinic, Department of Urology (United States); Friese, Jeremy L. [Mayo Clinic, Department of Radiology (United States); Wang, Zhen; Murad, M. Hassan [Mayo Clinic, Division of Preventive, Occupational, and Aerospace Medicine (United States); Schmit, Grant D. [Mayo Clinic, Department of Radiology (United States)

    2016-02-15

    IntroductionOnce reserved solely for non-surgical cases, percutaneous ablation is becoming an increasingly popular treatment option for a wider array of patients with small renal masses and the radiation risk needs to be better defined as this transition continues.Materials and MethodsRetrospective review of our renal tumor ablation database revealed 425 patients who underwent percutaneous ablation for treatment of 455 renal tumors over a 5-year time period. Imparted radiation dose information was reviewed for each procedure and converted to effective patient dose and skin dose using established techniques. Statistical analysis was performed with each ablative technique.ResultsFor the 331 cryoablation procedures, the mean DLP was 6987 mGycm (SD = 2861) resulting in a mean effective dose of 104.7 mSv (SD = 43.5) and the mean CTDI{sub vol} was 558 mGy (SD = 439) resulting in a mean skin dose of 563.2 mGy (SD = 344.1). For the 124 RFA procedures, the mean DLP was 3485 mGycm (SD = 1630) resulting in a mean effective dose of 50.3 mSv (SD = 24.0) and the mean CTDI{sub vol} was 232 mGy (SD = 149) resulting in a mean skin dose of 233.2 mGy (SD = 117.4). The difference in patient radiation exposure between the two renal ablation techniques was statistically significant (p < 0.001).ConclusionBoth cryoablation and RFA imparted an average skin dose that was well below the 2 Gy deterministic threshold for appreciable sequela. Renal tumor cryoablation resulted in a mean skin and effective radiation dose more than twice that for RFA. The radiation exposure for both renal tumor ablation techniques was at the high end of the medical imaging radiation dose spectrum.

  8. [Examination of percutaneous microwave coagulation and radiofrequency ablation therapy for metastatic liver cancer].

    Science.gov (United States)

    Ohkawa, Shinichi; Hirokawa, Satoru; Masaki, Takahiro; Miyakawa, Kaoru; Tarao, Kazuo; Akaike, Makoto; Sugimasa, Yukio; Takemiya, Shoji; Sairenji, Motonori; Motohashi, Hisahiko

    2002-11-01

    Percutaneous microwave coagulation therapy (PMCT) and radio frequency ablation therapy (RFA) as treatments for metastatic liver cancer were examined. PMCT or RFA was administered for 18 metastatic liver cancer lesions (primary lesion: 11 colon rectal cancer, one esophagus cancer, one thyroid cancer, one pancreatic cancer, one pheochromocytoma) in 16 patients from July 1999 to March 2002. RFA was performed 1 time for 12 minutes in principle, using a Cool-tip RF system from Radionics. Patients had a mean age of 58.8 years and the mean diameter of the neoplasms was about 22 mm. Critical complications were not seen. The rate of partial recurrence was 35.3% as of March, 2002, in an average observation period of 7.3 months. On the other hand, with the medical treatment for the hepatocellular carcinoma provided during this period, the rate of partial recurrence was 14.8%. The treatment of metastatic liver cancer by PMCT and RFA is associated with a high rate of a recurrence as compared with hepatocellular carcinoma, and needs to be examined to discover ways of adaptation and improvement of the technology.

  9. Percutaneous radiofrequency ablation of lung tumors: evaluation of the literature using evidence-based techniques.

    LENUS (Irish Health Repository)

    Chan, Victoria O

    2012-02-01

    PURPOSE: The aim of this study was to evaluate the literature for articles assessing radiofrequency ablation (RFA) for pulmonary malignancy. MATERIALS AND METHODS: The "bottom-up" approach to evidence-based practice was applied by 2 reviewers to the retrieval and appraisal of original research articles published on pulmonary RFA between 2002 and 2009. Primary lung cancer and pulmonary metastases data were analyzed separately. The relationship between the percentage of local recurrence rate and lesion size, patient age, follow-up duration, and time to local recurrence was assessed using Spearman\\'s rank correlation. Discrete time series were used to evaluate time trends. RESULTS: Secondary evidence yielded 1 review of 26 observational studies. Primary evidence yielded 46 studies that seemed suitable for detailed appraisal. A total of 2905 ablations were performed in 1584 patients. Eight studies evaluated primary lung cancers alone, 11 evaluated pulmonary metastases alone, 25 evaluated both, and 2 did not specify the histology. Results revealed trends toward increasing use of conscious sedation over general anesthesia, increasing use of multitined probes, decreasing size of nodule selection, and use of positron emission tomography\\/computed tomography as the optimal follow-up tool. Mean morbidity was 24.6%. The most prevalent side effects included pneumothorax (28.3%), pleural effusions (14.8%), and pain (14.1%). Procedure-related mortality ranged from 0 to 5.6, with an overall procedure-related mortality rate of 0.21%. There were 282 (12.2%) local recurrences occurring at a mean of 13 months. The mean overall survival rate was 59.4%, and the cancer-specific survival rate was 82.6%. CONCLUSIONS: This evidence-based practice review of pulmonary RFA shows it to be a promising treatment for pulmonary malignancy in carefully selected patient populations. Studies with higher levels of evidence, including case-control, prospective nonrandomized and randomized trials

  10. Ultrasound-guided percutaneous thermal ablation of hepatocellular carcinoma using microwave and radiofrequency ablation

    Energy Technology Data Exchange (ETDEWEB)

    Xu, H.-X.; Xie, X.-Y.; Lu, M.-D. E-mail: lumd@21cn.com; Chen, J.-W.; Yin, X.-Y.; Xu, Z.-F.; Liu, G.-J

    2004-01-01

    AIM: To investigate the therapeutic efficacy of thermal ablation for treatment of hepatocellular carcinoma (HCC) using microwave and radiofrequency (RF) energy application. MATERIALS AND METHODS: A total of 190 nodules in 97 patients (84 male, 13 female; mean age 53.4 years, range 24-74 years) with HCC were treated with microwave or RF ablation in the last 4 years. The applicators were introduced into the tumours under conscious analgesic sedation by intravenous administration of fentanyl citrate and droperidol and local anaesthesia in both thermal ablation procedures. The patients were then followed up with contrast-enhanced computed tomography (CT) to evaluate treatment response. Survival was analysed using the Kaplan-Meier method. RESULTS: Complete ablation was obtained in 92.6% (176/190) nodules. The complete ablation rates were 94.6% (106/112) in microwave ablation and 89.7% (70/78) in RF ablation. The complete ablation rates in tumours{<=}2.0, 2.1-3.9 and {>=}4.0 cm were 93.1, 93.8 and 86.4%, respectively. Local recurrence was found in 9.5% nodules and the rates in tumours{<=}2.0, 2.1-3.9 and {>=}4.0 cm in diameter were 3.4, 9.9 and 31.8%, respectively. In the follow-up period, 7.1% nodules ablated by microwave and 12.8% by RF presented local recurrence. The 1, 2 and 3-year distant recurrence-free survivals were 47.2, 34.9 and 31.0%, respectively. Estimated mean survival was 32 months, and 1, 2 and 3-year cumulative survivals were 75.6, 58.5, and 50.0%, respectively. One and 2 years survivals of Child-Pugh class A, B and C patients were 83.8 and 70.4%, 78.2 and 53.2%, 36.3 and 27.3%, respectively. CONCLUSION: Thermal ablation therapy by means of microwave and RF energy application is an effective and safe therapeutic technique for hepatocellular carcinoma. Large tumours can be completely ablated, but have a significantly higher risk of local recurrence at follow-up.

  11. Percutaneous

    Directory of Open Access Journals (Sweden)

    Hazem Khamis

    2014-03-01

    Conclusions: Our initial results with the MitraClip device in a very small number of patients indicate that percutaneous edge-to-edge mitral valve repair is feasible and may be accomplished with favorable short-term safety and efficacy results.

  12. Long - term Efficacy of Computed Tomography - guided Percutaneous Radiofrequency Thermocoagulation for Glossopharyngeal Neuralgia%CT 引导下射频热凝术治疗舌咽神经痛的长期疗效分析

    Institute of Scientific and Technical Information of China (English)

    王小平; 左欣鹭; 曾塬杰; 倪家骧

    2016-01-01

    Objective To observe the long - term efficacy and adverse reactions of computed tomography( CT) -guided percutaneous radiofrequency thermocoagulation(PRT)in the treatment of glossopharyngeal neuralgia(GPN). Methods The study enrolled 80 GNP patients who received treatment and underwent CT - guided PRT in the Department of Pain Management,Xuanwu Hospital Capital Medical University from January 2003 to December 2014. The status of pain remission of the patients after surgery was observed,and pain relief rates and adverse reactions(including paresthesia in the root of tongue and pharynx,dysphagia,decreased gag reflex,cranial nerve damage and death )were recorded 3 months,6 months,1 year,3 years,5 years and 10 years after surgery. Results Among the 80 patients,63 (78. 8% ) had pain relief,and other 17 (21. 2% )had decrease in pain and used antiepileptic drug to control pain. The 3 months,6 months,1 year,3 years,5 years and 10 years relief rates were 77. 5% ,75. 0% ,73. 2% ,63. 0% ,53. 2% and 43. 0% respectively. Paresthesia in the root of tongue and pharynx occurred in 11(13. 8% )patients,among which 8 patients saw the paresthesia disappear(25. 3 ± 12. 6) weeks later and the rest 3 patients saw the paresthesia persistently exist but have slight influence on life. Dysphagia occurred in 5 (6. 3% )patients and decreased gag reflex occurred in 2(2. 5% )patients. The above two symptoms disappeared 2 weeks after surgery. No patients had cranial nerve damage or death. Conclusion CT - guided PRT provides favorable long - term efficacy in the treatment of GPN and causes no serious adverse reactions,which is worth clinical application.%目的:观察 CT 引导下射频热凝术治疗舌咽神经痛(GPN)的长期疗效和不良反应。方法选取2003年1月—2014年12月于首都医科大学宣武医院疼痛科就诊的行 CT 引导下射频热凝术的 GPN 患者80例,观察患者术后疼痛缓解情况及术后3个月、6个月、1年、3年、5年、10年疼痛

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

    Energy Technology Data Exchange (ETDEWEB)

    Prud' homme, Clara; Nueffer, Jean-Philippe; Runge, Michel; Dubut, Jonathan [University Hospital of Besancon, Department of Musculoskeletal Imaging, Besancon (France); Kastler, Bruno [University Hospital of Besancon, Department of Musculoskeletal Imaging, Besancon (France); I4S Laboratory, INSERM EA4268, University of Franche-Comte, Besancon (France); Aubry, Sebastien [University Hospital of Besancon, Department of Musculoskeletal Imaging, Besancon (France); Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, Besancon (France)

    2017-03-15

    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). 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. 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 x 15 x 16 mm. 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. (orig.)

  14. A Novel CT-Guided Transpsoas Approach to Diagnostic Genitofemoral Nerve Block and Ablation

    Science.gov (United States)

    Parris, David; Fischbein, Nancy; Mackey, Sean; Carroll, Ian

    2010-01-01

    Background Inguinal hernia repair is associated with a high incidence of chronic postsurgical pain. This pain may be caused by injury to the iliohypogastric, ilioinguinal, or genitofemoral nerves. It is often difficult to identify the specific source of the pain, in part, because these nerves are derived from overlapping nerve roots and closely colocalize in the area of surgery. It is therefore technically difficult to selectively block these nerves individually proximal to the site of surgical injury. In particular, the genitofemoral nerve is retroperitoneal before entering the inguinal canal, a position that puts anterior approaches to the proximal nerve at risk of transgressing into the peritoneum. We report a computed tomography (CT)-guided transpsoas technique to selectively block the genitofemoral nerve for both diagnostic and therapeutic purposes while avoiding injury to the nearby ureter and intestines. Case A 39-year-old woman with chronic lancinating right groin pain after inguinal hernia repair underwent multiple pharmacologic interventions and invasive procedures without relief. Using CT and Stimuplex nerve stimulator guidance, the genitofemoral nerve was localized on the anterior surface of the psoas muscle and a diagnostic block with local anesthetic block was performed. The patient had immediate relief of her symptoms for 36 hours, confirming the diagnosis of genitofemoral neuralgia. She subsequently underwent CT-guided radiofrequency and phenol ablation of the genitofemoral nerve but has not achieved long-term analgesia. Conclusion CT-guided transpsoas genitofemoral nerve block is a viable option for safely and selectively blocking the genitofemoral nerve for diagnostic or therapeutic purposes proximal to injury caused by inguinal surgery. PMID:20546515

  15. Accuracy and efficacy of percutaneous biopsy and ablation using robotic assistance under computed tomography guidance: a phantom study.

    Science.gov (United States)

    Koethe, Yilun; Xu, Sheng; Velusamy, Gnanasekar; Wood, Bradford J; Venkatesan, Aradhana M

    2014-03-01

    To compare the accuracy of a robotic interventional radiologist (IR) assistance platform with a standard freehand technique for computed-tomography (CT)-guided biopsy and simulated radiofrequency ablation (RFA). The accuracy of freehand single-pass needle insertions into abdominal phantoms was compared with insertions facilitated with the use of a robotic assistance platform (n = 20 each). Post-procedural CTs were analysed for needle placement error. Percutaneous RFA was simulated by sequentially placing five 17-gauge needle introducers into 5-cm diameter masses (n = 5) embedded within an abdominal phantom. Simulated ablations were planned based on pre-procedural CT, before multi-probe placement was executed freehand. Multi-probe placement was then performed on the same 5-cm mass using the ablation planning software and robotic assistance. Post-procedural CTs were analysed to determine the percentage of untreated residual target. Mean needle tip-to-target errors were reduced with use of the IR assistance platform (both P robotic IR assistance platform. This technology may be useful for clinical CT-guided biopsy and RFA, when accuracy may have an impact on outcome. • A recently developed robotic intervention radiology assistance platform facilitates CT-guided interventions. • Improved accuracy of complex needle insertions is achievable. • IR assistance platform use can improve target ablation coverage.

  16. Treatment Failure After Image-Guided Percutaneous Radiofrequency Ablation (RFA) of Renal Tumors - A Systematic Review with Description of Type, Frequency, Risk Factors and Management.

    Science.gov (United States)

    Vollherbst, Dominik; Bertheau, Robert; Kauczor, Hans-Ulrich; Radeleff, Boris Alexis; Pereira, Philippe L; Sommer, Christof-Matthias

    2017-03-01

    Background Radiofrequency ablation (RFA) is an established treatment for small renal tumors. The objective of this review is to systematically assess the type, frequency, risk factors and management of treatment failure after image-guided percutaneous RFA of renal tumors. Method 10 studies (967 patients, 1033 tumors) with a mean/median follow-up of ≥ 30 months were systematically identified and analyzed. Results and Conclusion Image-guided percutaneous RFA of localized renal tumors is very effective. The most common type of treatment failure is residual unablated tumor (5.9 %), followed by local tumor progression (4.7 %). De novo tumors in the kidneys occur in 1.3 % of cases and extra-renal metastases in 2.0 %. Local tumor progression, de novo tumors in the kidneys and extra-renal metastases occur predominantly later than 12 months after initial RFA. Tumor size > 3 cm and central tumor location are the major risk factors for treatment failure. In the case of treatment failure, repeated RFA shows high success rates (86.3 % for residual unablated tumors and 87.5 % for local tumor progression). Key Points: · Treatment failure can be subdivided into residual unablated tumor and local tumor progression.. · Residual unablated tumor occurs in 5.9 % of cases.. · Local tumor progression occurs in 4.7 % of cases.. · Tumor size and location are the major risk factors for treatment failure.. · Repeated RFA is effective and commonly used for management.. Citation Format · Vollherbst D, Bertheau R, Kauczor H et al. Treatment Failure After Image-Guided Percutaneous Radiofrequency Ablation (RFA) of Renal Tumors - A Systematic Review with Description of Type, Frequency, Risk Factors and Management. Fortschr Röntgenstr 2017; 189: 219 - 227.

  17. CT guided 125iodine seed implantation for portal vein tumor thrombus in primary hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    ZHANG Fu-jun; LI Chuan-xing; JIAO De-chao; ZHANG Nian-hua; WU Pei-hong; DUAN Guang-feng; WU Yue-xia

    2008-01-01

    Background This study evaluated the clinical application of CT guided 125iodine implantation in patients with portal vein tumor thrombus in primary hepatocellular carcinoma.Methods The ten patients (9 males and 1 female,aged from 36 to 72 years) with portal vein tumor thrombus accompanying hepatocellular carcinoma had been treated with comprehensive therapy including surgery,transcatheter arterial chemoembolization,radiotherapy ablation,microwave ablation or percutaneous ethanol injection.The average diameter of each tumor thrombus was 21.5 mm×30.5 mm.Seeds of 30 MBq 125I were implanted 5 mm apart within the portal vein tumor thrombus.The follow-up after 4 months included enhanced spiral CT.Results CT screening of the tumours indicated that 4 out of 10 patients showed complete response to the therapy,5 partial response and 1 stable disease.Adverse effects included aggravated abdominal dropsy and temporarily increased transaminase,which were controlled by medical management.Severe complications such as haemorrhage,biliary fistula,hepatic abscess,pancreatic fistula and hepatic function failure were not observed.Implanted seeds migrated to lung and left hepatic lobe in 1 case.Conclusion CT guided implantation of 125iodine seeds,can effectively treat portal vein tumor thrombus accompanying hepatocellular carcinoma with minimal damage and few complications.

  18. Extrapleural paravertebral CT guided fine needle biopsy of subcarinal lymph nodes

    Energy Technology Data Exchange (ETDEWEB)

    Tantawy, Wahid H., E-mail: tantawyw@yahoo.com [Radiology Department, Faculty of Medicine, Ain Shams University, Egypt Abbassyia square, Cairo (Egypt); El-Gemeie, Emad H. [Pathology Department, National Cancer Institute, Fom El Khalige Faculty of Medicine, Cairo University (Egypt); Ibrahim, Ahmed S., E-mail: asibrahima@gmail.com [Radiology Department, Faculty of Medicine, Ain Shams University, Egypt Abbassyia square, Cairo (Egypt); Mohamed, Mona A. [Radiology Department, Faculty of Medicine, Ain Shams University, Egypt Abbassyia square, Cairo (Egypt)

    2012-10-15

    Purpose: To report our experience in CT guided extrapleural paravertebral subcarinal lymph biopsy using a thin 25 gauge (25 G) thin needle without the need of injection of saline to widen the mediastinum. Materials and methods: Biopsy was performed using a 25 G needle which was advanced lateral to the vertebral body between the endothoracic fascia and the parietal pleura to gain access to subcarinal lymph nodes. One hundred and forty one patients were included in the study (74 females, 57 males). No artificial widening of the mediastinum using saline injection was required. The study was performed in the presence of a cytopathologist; sensitivity and specificity rates were calculated. Complications were documented for each case especially for pneumothorax and haemorrhage. Results: Cytopathological diagnosis was reached in all cases. All re-aspirations were done in the same session to reach a primary diagnosis at the time of the biopsy. Imunophenotyping study was done in 94 cases to confirm the primary diagnosis and to classify the malignant lesions. No pneumothorax was encountered. Small haematomas were noted in 5 cases (3.5%). Cytopathology showed a sensitivity of 97.2% and specificity of 100%. By adding immunophenotyping a 100% sensitivity and specificity was achieved. Conclusion: Fine needle aspiration cytology (FNAC) using a 25 gauge needle for subcarinal lymph nodes via a percutaneous extrapleural paravertebral CT guided approach is a safe, minimally invasive, and tolerable procedure yielding a high sensitivity and specificity rates without the need of artificial widening.

  19. Liver malignancies: CT-guided interstitial brachytherapy in patients with unfavorable lesions for thermal ablation.

    Science.gov (United States)

    Ricke, Jens; Wust, Peter; Wieners, Gero; Beck, Alexander; Cho, Chie Hee; Seidensticker, Max; Pech, Maciej; Werk, Michael; Rosner, Christian; Hänninen, Enrique Lopez; Freund, Torsten; Felix, Roland

    2004-11-01

    To evaluate computed tomography (CT)-guided brachytherapy in patients with very large liver malignancies or with liver tumors located adjacent to the liver hilum. In this prospective nonrandomized phase II trial, we treated 20 patients (19 liver metastases and one cholangiocarcinoma) with CT-guided high-dose-rate (HDR) brachytherapy using a (192) Iridium source. All patients demonstrated no functional liver degradation prior to irradiation. Entry criteria were liver tumors > 5 cm (group A, n = 11, no upper limit) or liver tumors brachytherapy was performed with three dimensional (3D) CT data acquired after percutaneous applicator positioning. Magnetic resonance (MR) imaging follow-up was performed 6 weeks and every 3 months post intervention. Primary endpoints were complications, local tumor control (absence of tumor growth after treatment followed by shrinkage of the lesion starting at 6 months) and progression-free survival. The mean tumor diameter was 7.7 cm (range, 5.5-10.8 cm) in group A, 3.6 cm (range, 2.2-4.9 cm) in group B. On average, a minimal dose of 17 Gy in the target volume was applied (range, 12-25 Gy). Severe side effects were recorded in two patients (10%). One patient demonstrated an obstructive jaundice caused by tumor edema after irradiation of a metastasis adjacent to the bile duct bifurcation. One patient developed intra-abdominal hemorrhage that was treated by a single blood transfusion and has ceased. We frequently encountered moderate increases of liver enzymes (70% of patients) and bilirubin (50% of patients) without clinical symptoms and thus considered to be insignificant. The median follow-up was 13 months. In group A (tumors > 5 cm), primary local tumor control after 6 and 12 months was 74% and 40%, respectively; in group B, it was 100% and 71%, respectively. All but one local recurrence (in a patient with diffuse tumor progression) were successfully treated during another CT-guided brachytherapy leading to a primary assisted local

  20. Symptomatic lumbar facet joint cysts treated by CT-guided intracystic and intra-articular steroid injections

    Energy Technology Data Exchange (ETDEWEB)

    Amoretti, Nicolas; Huwart, Laurent; Amoretti, Marie-Eve; Pellegrin, Amelie; Marcy, Pierre-Yves [Centre Hospital-Universitaire de Nice, Hopital Archet 2, Department of Radiology, Nice (France); Foti, Pauline [Centre Hospital-Universitaire de Nice, Departments of Epidemiology, Nice (France); Boileau, Pascal [Centre Hospital-Universitaire de Nice, Orthopaedic Surgery, Nice (France); Hauger, Olivier [Hopital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Department of Radiology, Bordeaux (France)

    2012-12-15

    To evaluate percutaneous computed tomography (CT)-guided intracystic and intra-articular steroid injections for the treatment of lumbar facet joint cyst causing radicular pain. A single-centre prospective study involving 120 consecutive patients with symptomatic lumbar facet joint cyst-induced radicular pain was done (72 women, 48 men). The average age was 68.2 years (52-84). Patients were treated by percutaneous CT-guided intracystic and intra-articular steroid injections. The clinical course of nerve root pain was evaluated after 1 day, and 1, 3 and 6 months, with long-term follow-up after 12 months. Patient follow-ups in our series show supportive results: within 120 patients, 54% of patients were satisfied with a long-lasting result from the first intra-cystic and intra-articular steroid injections (n = 65), while 20.8% were satisfied with a long-lasting result from a second intervention. Combining these two results shows that 75% of patients were satisfied with a long-lasting result. Our results showed that percutaneous treatment of vertebral lumbar facet joint cysts by double injections is an effective and economic therapeutic technical management among 75% of our patients. Thus we recommend that it should be considered as a first choice of treatment. (orig.)

  1. [Quality assurance of rapid on-site evaluation of CT-guided fine-needle aspiration cytology of lung nodules].

    Science.gov (United States)

    Bak, Mihály; Hidvégi, Judit; Andi, Judit; Bahéry, Mária; Kovács, Eszter; Schneider, Ferenc; Kostic, Szilárd; Rényi-Vámos, Ferenc; Szőke, János; Nyári, Tibor; Gődény, Mária; Kásler, Miklós

    2013-01-06

    The methods available for the diagnosis of lung cancer include radiologic, cytologic and pathologic procedures. The aim of this study was to determine the quality assurance of CT guided fine needle aspiration cytology of lung nodules. Cytology results were rated to 4 categories (positive; suspicious; negative; not representative). All cytology reports were compared with the final histology diagnosis. A total of 128 patients underwent CT-guided percutaneous fine-needle aspiration biopsy cytology (63 males; 65 females; mean age 62.8 years). Smears were adequate in 99 cases and inadequate in 29 cases. The average diameter of the nodules was 3.28 cm. Thirty three (25.6%) of the cases were histologically verified and 2 falsely negative and 2 falsely positive cases were detected. The sensitivity and the positive predictive value were 88.8% and 88.8%, respectively. Pneumothorax developed in 7 (5.4%) cases. These results suggest that CT-guided transthoracic fine needle aspiration cytology has a high diagnostic accuracy and an acceptable complication rate. The auditing valves of the results meet the proposed threshold values.

  2. Treatment of hepatocellular carcinoma adjacent to large blood vessels using 1.5T MRI-guided percutaneous radiofrequency ablation combined with iodine-125 radioactive seed implantation

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Zheng-Yu, E-mail: linsinlan@yahoo.com.cn [The Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou 350005 (China); Chen, Jin, E-mail: snow8968851@163.com [The Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou 350005 (China); Deng, Xiu-Fen, E-mail: dxf197286@yahoo.com.cn [The Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou 350005 (China)

    2012-11-15

    Objective: The objective is to study the technology associated with and feasibility of the treatment of hepatocellular carcinoma (HCC) adjacent to large blood vessels using 1.5T MRI-guided radiofrequency ablation combined with iodine-125 (I-125) radioactive seed implantation. Methods: Sixteen patients with a total of 24 HCC lesions (average maximum diameter: 2.35 {+-} 1.03 cm) were pathologically confirmed by biopsy or clinically diagnosed received 1.5T MRI-guided percutaneous radiofrequency ablation (RFA) treatment. Each patient had one lesion adjacent to large blood vessels ({>=}3 mm); after the ablation, I-125 radioactive seeds were implanted in the portions of the lesions that were adjacent to the blood vessels. Results: All the ablations and I-125 radioactive seed implantations were successful; a total of 118 seeds were implanted. The ablated lesions exhibited hypointense signals on the T2WI sequence with a thin rim of hyperintense signals; they also exhibited significant hyperintense signals on the T1WI sequence with clear boundaries. The average follow-up period was 11.1 {+-} 6.2 months. There were 23 complete responses and one partial response in the 24 lesions. The alpha-fetoprotein (AFP) levels of the patients significantly decreased. Conclusion: The 1.5T MRI-guided RFA combined with I-125 radioactive seed implantation for the treatment of HCC adjacent to large blood vessels is an effective technology.

  3. Percutaneous radiofrequency ablation: relationship between different probe types and procedure time on length and extent of osteonecrosis in dog long bones

    Energy Technology Data Exchange (ETDEWEB)

    Martel, J.; Bueno, A. [Fundacion Hospital Alcorcon, Departamento de Diagnostico por Imagen, Alcorcon, Madrid (Spain); Dominguez, M.P. [Fundacion Hospital Alcorcon, Departamento de Patologia, Alcorcon, Madrid (Spain); Llorens, P.; Quiros, J.; Delgado, C. [Universidad Complutense, Facultad de Veterinaria, Madrid (Spain)

    2008-02-15

    We have been using radiofrequency ablation for the percutaneous treatment of osteoid osteoma since 2001. Frequently, lesions are located near the joint surface, involve the vertebral body or are close to major nerves. We seek to determine whether radiofrequency ablation (RFA) can be used safely in these cases. A total of 65 lesions were induced in 4 dogs. Each dog underwent RFA on the diaphysis of long bones, as well as femoral and humeral heads. Four different sessions were carried out by using 1- and 2-cm probes with or without a cool-tip system and by varying the timing of the procedure. Plain film, CT, and MRI were obtained. All bone samples were examined histologically. The dogs' activity after the procedure was normal. No pathologic fractures occurred despite unrestricted activity of the animals. Cortical bone was always respected; therefore, articular cartilage has not been damaged. Radiological findings were characteristic. There were no significant differences in lesion size, probe type, and the duration of the procedure. The mean lesion diameter perpendicular to the electrode was 18.5 mm. Our study confirms the insulative effect of cortical bone. RFA can be safely performed close to the joint surface without damaging the cartilage. (orig.)

  4. Effectiveness of combined use of imprint cytological and histological examination in CT-guided tissue-core biopsy.

    Science.gov (United States)

    Yamagami, Takuji; Yoshimatsu, Rika; Kajiwara, Kenji; Ishikawa, Masaki; Matsumoto, Tomohiro; Kakizawa, Hideaki; Toyoda, Naoyuki; Hasebe, Terumitsu; Awai, Kazuo

    2014-05-01

    This study evaluated the efficacy of the combination of imprint cytology and histology in tissue-core percutaneous biopsy under real-time computed tomography (CT) fluoroscopic guidance. Between October 2009 and June 2013, 156 percutaneous needle biopsies were performed in our institution. Those obtained by tissue-core biopsy underwent both imprint cytological and histological examinations routinely after touch imprint cytology was performed on site to evaluate the samples' sufficiency for cytological and pathological examination. Final diagnosis was confirmed by independent surgical pathology, independent culture results or clinical follow-up. Rates of adequate specimens and precise diagnosis, by combined cytological and histological examination were 100 % (156/156) and 96.2 % (150/156), by cytology 94.4 % (152/156) and 83.3 % (130/156) and by histology 99.3 % (155/156) and 92.3 % (144/156). Precise diagnosis was achieved by combined examinations in 94.7 % (89/94) of thoracic lesions, 97.6 % (40/41) of musculoskeletal lesions, and 100 % (21/21) of abdominal, pelvic and retroperitoneal lesions. In all 104 lesions diagnosed as malignant by CT-guided biopsy and in 30 of 52 diagnosed as benign, specific cell types could be proved by combined examinations. Combined imprint cytology and histology performed after on-site touch imprint cytological evaluation improved the diagnostic ability of CT fluoroscopically guided biopsy. • CT-guided needle biopsy is a well-established diagnostic technique. • Touch imprint cytological evaluation on site is helpful in improving quality of CT-guided biopsy. • The rate of diagnosing malignant lymphoma specifically with cytological examination is relatively low. • The rate of specific diagnosis of benign lesion in musculoskeletal regions is low.

  5. PET/CT-guided Interventions: Personnel Radiation Dose

    Energy Technology Data Exchange (ETDEWEB)

    Ryan, E. Ronan, E-mail: ronan@ronanryan.com; Thornton, Raymond; Sofocleous, Constantinos T.; Erinjeri, Joseph P. [Memorial Sloan-Kettering Cancer Center, Department of Radiology (United States); Hsu, Meier [Memorial Sloan-Kettering Cancer Center, Department of Epidemiology and Biostatistics (United States); Quinn, Brian; Dauer, Lawrence T. [Memorial Sloan-Kettering Cancer Center, Department of Medical Physics (United States); Solomon, Stephen B. [Memorial Sloan-Kettering Cancer Center, Department of Radiology (United States)

    2013-08-01

    PurposeTo quantify radiation exposure to the primary operator and staff during PET/CT-guided interventional procedures.MethodsIn this prospective study, 12 patients underwent PET/CT-guided interventions over a 6 month period. Radiation exposure was measured for the primary operator, the radiology technologist, and the nurse anesthetist by means of optically stimulated luminescence dosimeters. Radiation exposure was correlated with the procedure time and the use of in-room image guidance (CT fluoroscopy or ultrasound).ResultsThe median effective dose was 0.02 (range 0-0.13) mSv for the primary operator, 0.01 (range 0-0.05) mSv for the nurse anesthetist, and 0.02 (range 0-0.05) mSv for the radiology technologist. The median extremity dose equivalent for the operator was 0.05 (range 0-0.62) mSv. Radiation exposure correlated with procedure duration and with the use of in-room image guidance. The median operator effective dose for the procedure was 0.015 mSv when conventional biopsy mode CT was used, compared to 0.06 mSv for in-room image guidance, although this did not achieve statistical significance as a result of the small sample size (p = 0.06).ConclusionThe operator dose from PET/CT-guided procedures is not significantly different than typical doses from fluoroscopically guided procedures. The major determinant of radiation exposure to the operator from PET/CT-guided interventional procedures is time spent in close proximity to the patient.

  6. Closed reduction with CT-guided screw fixation for unstable sacroiliac joint fracture-dislocation

    Energy Technology Data Exchange (ETDEWEB)

    Baskin, Kevin M.; Cahill, Ann Marie; Kaye, Robin D. [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Born, Christopher T. [Temple University Hospital/Temple Children' s Hospital, Temple Sports Medicine, Marlton, NJ (United States); Grudziak, Jan S. [Children' s Hospital of Pittsburgh, Department of Orthopedic Surgery, Pittsburgh, PA (United States); Towbin, Richard B.

    2004-12-01

    Unstable posterior pelvic ring fractures and dislocations are uncommon but potentially life-threatening injuries in children. Early definitive management reduces risk of immediate complications as well as chronic pain and gait dysfunction. Conventional operative therapy carries substantial risk of extensive blood loss and iatrogenic neurological and vascular injury. Minimally invasive image-guided intervention may further reduce immediate risk and improve long-term outcome. To describe CT-guided closed reduction and internal fixation (CRIF) and review outcomes of unstable fracture-dislocation of the sacroiliac (SI) joint in children. Between 2000 and 2003, three children (two girls, one boy) age 8-14 years were referred to interventional radiology for treatment of unstable SI joint fracture-dislocation not adequately treated with anterior external fixation alone. The three affected SI joints (two left, one right) were treated in a combined approach by pediatric interventional radiologists and orthopedic surgeons, using a percutaneous approach under CT guidance. Over a threaded guiding pin, 7.3 mm cannulated screws were used to achieve stable reduction of the affected SI joints. One screw was removed after slight (2 mm) migration. No neurovascular or other complications occurred. All patients had satisfactory healing with near-anatomic reduction, although recovery of the youngest was delayed by associated spinal injury. Compared to open surgical alternatives, CRIF under CT guidance reduces operating time, decreases blood loss, and allows early definitive fixation and immediate non-weight-bearing mobilization with a low rate of complication for unstable posterior pelvic ring fractures. In addition, CT-guided placement of the guide pin may allow safer screw positioning and may minimize the total number of screws needed to achieve pelvic stability. (orig.)

  7. Results and complications of CT-guided transthoracic fine-needle aspiration biopsy of pulmonary lesions

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    Lima, Cristiano Dias de; Nunes, Rodolfo Acatauassu; Saito, Eduardo Haruo; Higa, Claudio; Cardona, Zanier Jose Fernando; Santos, Denise Barbosa dos, E-mail: cristianodiaslima@gmail.co [Hospital Universitario Pedro Ernesto (HUPE/UERJ), Rio de Janeiro, RJ (Brazil). Dept. Cirurgia Toracica

    2011-03-15

    Objective: to analyze the cytological findings of CT-guided percutaneous fine-needle aspiration biopsies of the lung, to demonstrate the diagnostic feasibility of the method in the investigation of pulmonary lesions, and to determine the complications of the procedure, evaluating its safety. Methods: a retrospective analysis of 89 patients with various types of pulmonary lesions who underwent 97 procedures over a period of five years. The patients were divided into groups regarding the indication for the procedure: suspicion of primary lung cancer (stages IIIB or IV); suspicion of lung cancer (stages I, II, or IIIA) and clinical contraindications for surgery; suspicion of pulmonary metastasis from other organs; and pulmonary lesions with benign radiological aspect. All of the procedures were performed with 25-gauge needles and were guided by spiral CT. The final diagnosis was confirmed by surgical biopsy and clinical/oncological follow-up. For the analysis of complications, the total number of procedures was considered. Results: the main indication for the procedure was suspicion of advanced stage primary lung cancer. The accuracy of the method for malignant lesions was 91.5%. The lesion was confirmed as cancer in 73% of the patients. The major complication was pneumothorax (27.8%), which required chest tube drainage in 12.4% of the procedures. Conclusions: the principal indication for CT-guided fine-needle biopsy was suspicion of primary lung cancer in patients who were not surgical candidates. The procedure has high diagnostic feasibility for malignant pulmonary diseases. The most prevalent complication was pneumothorax. However, in most cases, chest tube drainage was unnecessary. No deaths were related to the procedure. (author)

  8. Percutaneous radiofrequency lesioning of the suprascapular nerve for the management of chronic shoulder pain: a case series

    Directory of Open Access Journals (Sweden)

    Simopoulos TT

    2012-04-01

    Full Text Available Thomas T Simopoulos, Jyotsna Nagda, Musa M AnerArnold Pain Management Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USAPurpose: The objective of this study was to retrospectively evaluate the analgesic effects of continuous radiofrequency lesioning of the suprascapular nerve (SSN for chronic shoulder pain. The authors sought to obtain insight into the time-sensitive analgesic success and complications of this therapy.Patients and methods: This study was a retrospective case series involving patients with unremitting shoulder pain that had lasted for at least 12 months. Patients were selected if they showed a reduction of at least 50% in pain intensity during the anesthetic phase after SSN block, no additional motor weakness of the shoulder, and pain relief lasting for less than 2 months after separate treatments of the SSN with depot corticosteroids and pulsed radiofrequency. Nine patients were referred to the Arnold Pain Management Center. Of these nine patients, six patients who had significant chronic shoulder pain unresponsive to oral medications and intra-articular injections and who were not considered surgical candidates were selected. These patients were treated with a single radiofrequency lesion of the SSN at 80°C for 60 seconds. The primary outcome was a reduction in pain intensity by 50%, as determined by the numeric rating scale, and duration of this effect. The secondary outcome was improvement in either the passive or the active range of motion (ROM. Patients were also monitored for adverse effects such as weakness or increased pain.Results: The pooled mean numeric rating scale score before the procedure was 7.2 ± 1.2; this fell to 3.0 ± 0.9 at 5–7 weeks post procedure. The duration of pain relief ranged from 3 to 18 months, and all patients underwent at least one additional treatment. The change in baseline ROM improved from an average of 60° ± 28° (flexion and 58° ± 28° (abduction

  9. CT-guided percutaneous intratumoral chemotherapy with a novel cisplatin/epinephrine injectable gel for the treatment of unresectable malignant liver tumors; CT-gesteuerte perkutane intratumorale Chemotherapie mit Cisplatin-/Adrenalin-Gel zur Behandlung inoperabler maligner Lebertumoren. Ergebnisse einer klinischen Phase-II-Pruefung

    Energy Technology Data Exchange (ETDEWEB)

    Engelmann, K.; Mack, M.G.; Straub, R.; Eichler, K.; Zangos, S.; Vogl, T.J. [Universitaetsklinikum Frankfurt (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Orenberg, E. [Matrix Pharmaceutical Inc., Fremont, CA (United States)

    2000-12-01

    Purpose: To evaluate prospectively the volumetric changes of tumor and necrosis in unresectable malignant liver tumors and the clinical aspects after CT-guided direct intratumoral administration of a novel cisplatin/epinephrine injectable gel in a clinical phase II study. Patients and methods: 8 patients with 17 colorectal liver metastases with a mean volume of 42 ml were treated with a mean of 5.1 injections and 8 patients with 11 HCC nodules (mean volume of 22.1 ml) with a mean of 3.25 treatments with CT-guided local administration of a novel cisplatin/epinephrine gel. This method of administration provides a higher local and lower systemic drug concentration. Volumes of tumor and necrosis prior to and after treatment were measured by computer-generated volumetric analysis. Results: Contrast-enhanced studies verified pretherapeutic tumor necrosis with a value of 12.6% in the metastases and 0.6% in the HCC nodules. Intratumoral drug administration resulted in a necrotic volume of 110% in metastases and 128% in HCC versus the mean initial tumor volume, at least 4 treatments resulted in 122% necrosis in metastases and 130% in HCC. Local therapy control rate for the follow-up to 6 months was 38% and 83.3% for the group of metastases and HCC, respectively. Conclusions: Direct intratumoral injection of a novel cisplatin/epinephrine injectable gel results in an induction of a relevant necrosis in malignant liver tumors, with a substantially higher local therapy control rate for HCC compared to colorectal metastases. (orig.) [German] Zielsetzung: Evaluation der Volumenaenderungen von Tumor und Nekrose nach CT-gesteuerter perkutaner intratumoraler Injektion eines neuartigen Cisplatin-/Adrenalin-Gels sowie der klinischen Aspekte diesewr Therapie bei Patienten mit inoperablen malignen Lebertumoren im Rahmen einer klinischen Phase-II-Studie. Patienten und Methoden: 8 Patienten mit 17 kolorektalen Lebermetastasen mit einem mittleren Volumen von 42 ml wurden mit

  10. Breath-hold after forced expiration before removal of the biopsy needle decreased the rate of pneumothorax in CT-guided transthoracic lung biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Min, Lingfeng; Xu, Xingxiang [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China); Song, Yong [Jinling Hospital, Nanjing University School of Medical, Nanjing 210002, Jiangsu (China); Issahar, Ben-Dov [Pulmonary Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Israel); Wu, Jingtao; Zhang, Le; Huang, Qian [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China); Chen, Mingxiang, E-mail: chenmx1129@126.com [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China)

    2013-01-15

    Purpose: To assess the effect of a breath-hold after forced expiration on the rate of pneumothorax after computed tomography (CT)-guided transthoracic needle biopsy of pulmonary lesions. Materials and methods: Between January 2008 and December 2011, percutaneous CT-guided lung biopsy was performed in 440 patients. Two hundred and twenty-one biopsies were performed without (control group) and two hundred and nineteen biopsies were performed with (study group) the study maneuver – a breath-hold after forced expiratory approach. Multivariate analysis was performed between groups for risk factors for pneumothorax, including patient demographics, lesion characteristics, and biopsy technique. Results: A reduced number of pneumothoraces (18 [8.2%] vs 35 [15.8%]; P = 0.014) but no significant difference in rate of drainage catheter insertions (2 [0.9%] vs (4 [1.8%]; P = 0.418) were noted in the study group as compared with the control group. By logistic regression analysis, three factors significantly and independently affected the risk for pneumothorax including lesion size (transverse and longitudinal diameter), distance from pleura and utilizing or avoiding the breath-hold after deep expiration maneuver. Conclusion: Breath-holding after forced expiration before removal of the biopsy needle during the percutaneous CT-guided transthoracic lung biopsy almost halved the rate of overall pneumothorax. Small lesion size (longitudinal diameter) and the distance from pleura were also predictors of pneumothorax in our study.

  11. CT-guided core needle biopsy of mediastinal nodes through a transpulmonary approach: retrospective analysis of the procedures conducted over six years.

    Science.gov (United States)

    Yin, Zhongyuan; Liang, Zhiwen; Li, Pengcheng; Wang, Qiong

    2017-08-01

    To retrospectively evaluate the diagnostic performance and complications of a CT-guided core needle cutting biopsy of mediastinal nodes through a transpulmonary approach. From January 2009 to December 2014, we used a coaxial positioning system and an 18G cutting-type biopsy device to perform CT-guided percutaneous transpulmonary needle biopsies of mediastinal nodes for 127 patients. The diagnostic performance, complication rate, influencing factors, distribution of mediastinal nodes and pathological diagnoses were investigated. Among 127 patients, pathologic analyses showed that all of the biopsies were technically successful. The sensitivity, specificity, positive predictive value, and negative predictive value were all 100%. As for complications, the ratios for pneumothorax and hemoptysis were 33.9% and 4.7%, respectively. Multivariate analyses revealed that the distance from the pleura to the target lesion (P = 0.008) and the numbers of visceral pleura injuries (P = 0.006) were the two most significant risk factors for pneumothorax, and that the distance from the pleura to the target lesion (P = 0.004) was the most significant risk factor for hemoptysis. CT-guided core needle cutting biopsy of mediastinal nodes through a transpulmonary approach is a safe and efficient diagnostic method. • CT-guided core needle biopsy is an accurate technique for diagnosing mediastinal nodes. • The rates of complications are similar to those for pulmonary lesion biopsy. • Pneumothorax risk factors include distance from pleura to target lesion and number of visceral pleura. • Distance from pleura to target lesion is the risk factor for hemoptysis. • CT-guided core needle biopsy is an important diagnostic method for mediastinal nodes.

  12. Preliminary clinical experience with a dedicated interventional robotic system for CT-guided biopsies of lung lesions: a comparison with the conventional manual technique.

    Science.gov (United States)

    Anzidei, Michele; Argirò, Renato; Porfiri, Andrea; Boni, Fabrizio; Anile, Marco; Zaccagna, Fulvio; Vitolo, Domenico; Saba, Luca; Napoli, Alessandro; Leonardi, Andrea; Longo, Flavia; Venuta, Federico; Bezzi, Mario; Catalano, Carlo

    2015-05-01

    Evaluate the performance of a robotic system for CT-guided lung biopsy in comparison to the conventional manual technique. One hundred patients referred for CT-guided lung biopsy were randomly assigned to group A (robot-assisted procedure) or group B (conventional procedure). Size, distance from entry point and position in lung of target lesions were evaluated to assess homogeneity differences between the two groups. Procedure duration, dose length product (DLP), precision of needle positioning, diagnostic performance of the biopsy and rate of complications were evaluated to assess the clinical performance of the robotic system as compared to the conventional technique. All biopsies were successfully performed. The size (p = 0.41), distance from entry point (p = 0.86) and position in lung (p = 0.32) of target lesions were similar in both groups (p = 0.05). Procedure duration and radiation dose were significantly reduced in group A as compared to group B (p = 0.001). Precision of needle positioning, diagnostic performance of the biopsy and rate of complications were similar in both groups (p = 0.05). Robot-assisted CT-guided lung biopsy can be performed safely and with high diagnostic accuracy, reducing procedure duration and radiation dose in comparison to the conventional manual technique. • CT-guided biopsy is the main procedure to obtain diagnosis in lung tumours. • The robotic device facilitates percutaneous needle placement under CT guidance. • Robot-assisted CT-guided lung biopsy reduces procedure duration and radiation dose.

  13. Percutaneous Radiofrequency Thermocoagulation for the Treatment of Different Types of Trigeminal Neuralgia:Evaluation of Quality of Life and Outcomes

    Institute of Scientific and Technical Information of China (English)

    黄轶忠; 倪家骧; 武百山; 何明伟; 杨力强; 王琦

    2010-01-01

    Radiofrequency thermocoagulation(RFT) of the gasserian ganglion is a routine and effective technique for the treatment of classical trigeminal neuralgia(CTN).In this study we compared its efficacy in patients with CTN and atypically symptomatic or mixed trigeminal neuralgia(MTN).Fifty-seven patients were treated with RFT for trigeminal neuralgia from June 2006 to February 2009.Thirty patients had CTN,and 27 had MTN.Outcomes were measured by using the visual analog pain scale(VAS) and patients' reports of qu...

  14. Transpulmonary computed tomography-guided radiofrequency ablation of liver neoplasms abutting the diaphragm with multiple bipolar electrodes

    Directory of Open Access Journals (Sweden)

    Q Zhang

    2015-01-01

    Full Text Available Background: Neoplasm abutting the diaphragm is one kind of the special sites of liver neoplasms treated with radiofrequency ablation (RFA, the purpose of this study is to evaluate the feasibility and safety of computed tomography (CT-guided RFA of liver neoplasms abutting the diaphragm with multiple bipolar electrodes sequentially passing through the lung parenchyma. Materials and Methods: 37 patients were treated with transpulmonary CT-guided RFA. Technical success rate, perioperative complications, and local tumor progression were investigated. Results: The number of electrode (s sequentially passing through the lung parenchyma (NPLP was 1 electrode in 20 patients, 2 electrodes in 14 cases, and 3 electrodes in 3 cases. Technical success rate was 100%. The most of the perioperative complications were self-limiting and mainly included pneumothorax (11 cases, 2 needed percutaneous drainage, hemorrhage of the electrode track in the lung parenchyma (6 cases, a small amount of hemoperitoneum in perihepatic space (8 cases and discomfort of the right shoulder (7 cases. Local tumor progression occurred in 6 cases during the follow-up (3–12 months. Multivariate logistic regression analysis showed that the incidence of pneumothorax was not related to NPLP (P = 0.50, length of the electrode (s in the lung parenchyma (P = 0.18, types of anesthesia (P = 0.10, and indwelling time of the electrode (s in the lung parenchyma (P = 0.28. Conclusion: CT-guided RFA of liver neoplasms abutting the diaphragm with multiple bipolar electrodes sequentially passing through the lung parenchyma is a feasible and safe therapeutic option.

  15. Percutaneous upper thoracic radiofrequency sympathectomy in Raynaud phenomenon: a comparison of T2/T3 procedure versus T2 lesion with phenol application.

    Science.gov (United States)

    Gabrhelik, Tomas; Michalek, Pavel; Adamus, Milan; Berta, Emil

    2009-01-01

    Percutaneous radiofrequency (RF) thoracic sympathectomy is an alternative method to surgical procedures for the treatment of acral ischemia in Raynaud phenomenon. The procedure is indicated if conservative therapy fails to provide sufficient relief. The aim of this study was to compare classic T2 and T3 RF thermolesioning with a less invasive procedure at the level of T2 only. Fifty adult patients, American Society of Anesthesiologists (ASA) classification I to III, were randomly assigned to 1 of 2 groups. T2 and T3 thoracic RF thermolesion was performed in 1 group, whereas T2 thermolesion with local application of 0.5 mL of 6% phenol was delivered in the second group. Changes in cold perception, pain, and quality of life were assessed using a questionnaire. Blood circulation in the upper extremity was evaluated using infrared thermography. Patients were observed for a period of 3 months. A significant decrease in pain according to visual analog scale (P Thoracic RF upper sympathectomy is an effective method in the treatment of resistant forms of Raynaud phenomenon. A single-shot procedure at the level of T2 may be preferable because of the shorter procedure duration of this technique.

  16. Percutaneous treatment of liver tumors with an adapted probe for cooled-tip, impedance-controlled radio-frequency ablation under open-magnet MR guidance: initial results

    Energy Technology Data Exchange (ETDEWEB)

    Kelekis, Alexis D.; Terraz, Sylvain; Roggan, Andre; Terrier, Francois; Majno, Pietro; Mentha, Gilles; Roth, Arnaud; Becker, Christoph D. [Department of Diagnostic and Interventional Radiology, University Hospital, 24 rue Micheli-du-Crest, 1211, Geneva (Switzerland)

    2003-05-01

    Percutaneous radio-frequency (RF) ablation of liver tumors is usually performed under guidance of real-time US, but some tumor nodules in some patients cannot be adequately visualized with this technique. We report our preliminary results with an MR-compatible, internally perfused 17-G RF probe adapted to a standard RF generator for impedance-controlled RF ablation under MR guidance. Following initial testing of the probe for MR compatibility, artifacts and macroscopic effects on an ex vivo pig liver, four patients with eight neoplastic liver nodules (five metastatic and three primary), which could not be properly targeted by US, were treated with the cooled-tip technique under MRI guidance in an open 0.23-T magnet. Metallic artifacts produced by the probe were useful for accurate placement and did not interfere with MRI monitoring at the end of the procedure. Based on imaging findings, the immediate result of RF was considered adequate in all instances. Local recurrence occurred in one instance after 6 months, requiring repeat treatment. No adverse effects were noted. Initial experience suggests that the probe we used allows to perform impedance-controlled cooled-tip RF ablation of liver tumors under open-magnet MR guidance. (orig.)

  17. Therapeutic Efficacy and Safety of Percutaneous Ethanol Injection with or without Combined Radiofrequency Ablation for Hepatocellular Carcinomas in High Risk Locations

    Energy Technology Data Exchange (ETDEWEB)

    Cha, Dong Ik; Lee, Min Woo; Rhim, Hyunchul; Choi, Dongil; Kim, Young-sun; Lim, Hyo K. [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of)

    2013-07-01

    To evaluate the therapeutic efficacy and safety of percutaneous ethanol injection (PEI) alone and combined with radiofrequency ablation (RFA) for hepatocellular carcinomas (HCCs) in high risk locations. We performed PEI for HCCs in RFA-high risk locations, either alone or in combination with RFA. There were 20 HCCs (1.7 ± 0.9 cm) in 20 patients (PEI group: n = 12; PEI + RFA group: n = 8). We evaluated technical success, local tumor progression and complications in both groups. Technical success was achieved in all HCCs in both groups. During follow-up, local tumor progression was found in 41.7% (5/12) in the PEI group, whereas 12.5% (1/8) for the PEI + RFA group (p = 0.32). Bile duct dilatation was the most common complication, especially when the tumors were in periportal locations; 55% (5/9) in the PEI group and 50% (2/4) in the PEI + RFA group (p = 1.00). One patient in the PEI group developed severe biliary stricture and upstream dilatation that resulted in atrophy of the left hepatic lobe. One patient treated with PEI + RFA developed cholangitis and an abscess. Combined PEI and RFA treatment has a tendency to be more effective than PEI alone for managing HCCs in high risk locations, although the difference is not statistically significant. Even though PEI is generally accepted as a safe procedure, it may cause major biliary complications for managing HCCs adjacent to the portal vein.

  18. Percutaneous ethanol injection therapy is comparable to radiofrequency ablation in hepatocellular carcinoma smaller than 1.5 cm: A matched case-control comparative analysis.

    Science.gov (United States)

    Yu, Su Jong; Yoon, Jung-Hwan; Lee, Jeong Min; Lee, Jae Young; Kim, Se Hyung; Cho, Young Youn; Yoo, Jeong-Ju; Lee, Minjong; Lee, Dong Hyeon; Cho, Yuri; Cho, Eun Ju; Lee, Jeong-Hoon; Kim, Yoon Jun; Kim, Chung Yong

    2016-08-01

    Although percutaneous ethanol injection therapy (PEIT) is best indicated for patients with small hepatocellular carcinoma (HCC), the survival advantage of PEIT needs confirmation in real-world practice. This study was approved by the institutional review board, and the informed consent was waived. The study included 535 consecutive patients with newly diagnosed early stage (Barcelona Clinic Liver Cancer [BCLC] 0 or A) HCC who underwent initially radiofrequency ablation (RFA) (n = 288) or PEIT (n = 247) from January 2005 to December 2010. The primary outcome was overall survival (OS) and the secondary outcome was time to progression (TTP). The longest diameters of tumors of the groups differed significantly and larger for RFA group than PEIT group (P HR], 1.690; 95% confidence interval [CI], 0.828-3.449; P = 0.149) and time to progression (HR, 1.160; 95% CI, 0.773-1.740; P = 0.474). PEIT and RFA show equal effectiveness in treating HCCs <1.5 cm in terms of OS and time to progression.

  19. Initial CT-guided needle biopsy of extremity skeletal lesions: Diagnostic performance and experience of a tertiary musculoskeletal center

    Energy Technology Data Exchange (ETDEWEB)

    Nouh, Mohamed Ragab, E-mail: mragab73@yahoo.com [Department of Radiology, Faculty of Medicine, Alexandria University (Egypt); Department of Radiology, Al-Razi Hospital, Sulibikhate 13001 (Kuwait); Abu Shady, Hamdy Mohamed, E-mail: hamdi_abushadi@yahoo.com [Department of Radiology, Al-Razi Hospital, Sulibikhate 13001 (Kuwait)

    2014-02-15

    Introduction: Appendicular long bones are the target for a wide spectrum of bony lesions with variable clinical presentations. Biopsy procedures are needed for subsequent proper patient's management. Most of the available literature globally assessed musculoskeletal biopsies with inclusion of repeat biopsy results. We thought to retrospectively assess the diagnostic performance of initial CT-guided percutaneous core needle biopsy (PCNB) of extremity long bone lesions in a tertiary musculoskeletal referral center. Patients and methods: We retrospectively analyzed the outcome of initial CT-guided PCNB of 49 patients who presented with extremity long bone lesions which were biopsied in our hospital during a 36 months’ time period. The diagnostic performance was assessed in terms of diagnostic yield and accuracy. Results: There were 34 males and 15 females with a mean age of 33.69 years (range from 4 to 77 years). The overall diagnostic yield of initial biopsies was 87.75% with a diagnostic accuracy of 82.85% derived from the surgically proven cases. The higher diagnostic yield was recorded with malignancy, presence of extra-osseous soft-tissue component as well as mixed and sclerotic lesions. The pathologies of the non-diagnostic biopsies included large-cell lymphoma, giant-cell tumor, langerhans cell histiocytosis, osteoid osteoma and a non-ossifying fibroma. Conclusion: Initial CT-guided PCNB in extremities’ long bones lesions showed high diagnostic performance in malignant, mixed and/or sclerotic lesions as well as lesions with extra-osseous exophytic tissue growth. Lack of extra-osseous components, benign and lytic lesions all had worse diagnostic performance.

  20. B 超引导与 CT 引导腹腔盆腔囊肿及脓肿经皮穿刺抽吸治疗的比较%Comparison of ultrasound-and CT-guided percutaneous drainage of abdominal and pelvic cyst and abscess

    Institute of Scientific and Technical Information of China (English)

    叶丽河; 沈薏; 古杰洪; 黄玉莲

    2012-01-01

    Objective To compare the efficacy between ultrasound- and CT—guided percutaneous drainage of abdominal and pelvic cyst and abscess. Methods The puncture frequency of ultrasound—guided (56 patients) and CT—guided (45 patients) percutaneous drainage of abdominal/pelvic cysts and abscesses was compared. Results Sixty-three punctures were made using ultrasound—guided drainage of 58 cysts or abscesses in 56 patients. Seventy—seven punctures were made using CT—guided drainage of 45 cysts or abscesses in 45 patients. Conclusion Ultrasound—guided percutaneous drainage is more effective and safer than CT—guided drainage of abdominal/pelvic cysts and abscesses.%目的 探讨比较B超引导与CT引导腹腔盆腔囊肿及脓肿经皮穿刺抽吸治疗的作用.方法 B超引导下腹腔盆腔囊肿及脓肿经皮穿刺抽吸治疗56例患者,CT引导下45例患者.结果 B超引导下共穿刺58个囊肿或脓肿,穿刺次数63次:CT引导下共穿刺45个囊肿或脓肿,穿刺次数77次.B超引导下行腹腔盆腔囊肿及脓肿经皮穿刺抽吸治疗每个囊肿或脓肿平均穿刺次数显著少于CT引导.结论 腹腔盆腔囊肿及脓肿经皮穿刺抽吸治疗术中,B超引导较CT引导具有更多的优势.

  1. CT-guided suprascapular nerve blocks: a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Schneider-Kolsky, M.E.; Pike, J.; Connell, D.A. [Department of Medical Imaging, Victoria House Private Hospital, 316 Malvern Road, Prahran 3181, Melbourne, Victoria (Australia)

    2004-05-01

    The objective of this study was to describe the suprascapular nerve block using CT guidance and to evaluate the short- and medium-term efficacy in a range of shoulder pathologies. CT-guided infiltration around the suprascapular nerve was performed with bupivacaine and Celestone Chronodose on 40 consecutive patients presenting with chronic shoulder pathologies unresponsive to conventional treatment. Patients were interviewed using the Shoulder Pain and Disability Index (SPADI) before the procedure, 30 min after the procedure and at 3 days, 3 weeks and 6 weeks afterwards. Within 30 min of the block overall pain scores decreased from a mean ({+-}SEM) pain score of 7.0 ({+-}0.4) to 3.5 ({+-}0.5) (n=39, P<0.001). At 3 days after the procedure, the mean overall improvement of the pain and disability scores were 20.4% ({+-}4.9, P<0.001) and 16.8% ({+-}4.8, P=0.004) respectively. Sustained pain relief and reduced disability were achieved in 10 of 35 (29%) patients at 3 weeks and longer. Patients suffering from soft tissue pathologies were the most likely patients to benefit from the injection. No serious side effects were noted. In some patients with chronic soft tissue pathologies who do not respond to conventional treatment, a CT-guided suprascapular nerve block can provide safe short- and medium-term relief from pain and disability. (orig.)

  2. CT guided diffuse optical tomography for breast cancer imaging

    Science.gov (United States)

    Baikejiang, Reheman; Zhang, Wei; Zhu, Dianwen; Li, Changqing

    2016-03-01

    Diffuse optical tomography (DOT) has attracted attentions in the last two decades due to its intrinsic sensitivity in imaging chromophores of tissues such as blood, water, and lipid. However, DOT has not been clinically accepted yet due to its low spatial resolution caused by strong optical scattering in tissues. Structural guidance provided by an anatomical imaging modality enhances the DOT imaging substantially. Here, we propose a computed tomography (CT) guided multispectral DOT imaging system for breast cancer detection. To validate its feasibility, we have built a prototype DOT imaging system which consists of a laser at wavelengths of 650 and an electron multiplying charge coupled device (EMCCD) camera. We have validated the CT guided DOT reconstruction algorithms with numerical simulations and phantom experiments, in which different imaging setup parameters, such as projection number of measurements, the width of measurement patch, have been investigated. Our results indicate that an EMCCD camera with air cooling is good enough for the transmission mode DOT imaging. We have also found that measurements at six projections are sufficient for DOT to reconstruct the optical targets with 4 times absorption contrast when the CT guidance is applied. Finally, we report our effort and progress on the integration of the multispectral DOT imaging system into a breast CT scanner.

  3. Low-dose techniques in CT-guided interventions.

    Science.gov (United States)

    Sarti, Marc; Brehmer, William P; Gay, Spencer B

    2012-01-01

    Computed tomography (CT)-guided interventions such as biopsy, drainage, and ablation may be significant sources of radiation exposure in both patients and radiologists. Simple CT techniques to reduce radiation dose may be employed without increasing the procedure time or significantly degrading image quality. To develop low-dose protocols, it is important to understand the key concepts of delivered radiation dose to patients and physicians during CT-guided interventions. Patient dose estimates are easily followed and are provided at CT workstations. Familiarity with dose estimates, which are expressed as CT dose index and dose-length product, is also important. Methods to reduce radiation exposure in patients and physicians include performing proper preprocedure planning and paying careful attention to technique during the planning stage, making use of personal protective equipment, performing CT fluoroscopy intermittently instead of in real time, and optimizing needle visualization. Representative examples of these techniques have resulted in dose reductions of as much as 89%. Alternative imaging technologies that do not use ionizing radiation, such as virtual and ultrasonographic guidance, may also be used to reduce radiation dose. Understanding dose contribution strategies to reduce radiation dose provides a safer, more efficient environment for patients and the radiology team.

  4. CT-guided localization of small pulmonary nodules using adjacent microcoil implantation prior to video-assisted thoracoscopic surgical resection

    Energy Technology Data Exchange (ETDEWEB)

    Su, Tian-Hao; Jin, Long; He, Wen [Capital Medical University, Department of Radiology, Beijing Friendship Hospital, Beijing (China); Fan, Yue-Feng [Xiamen University, Department of Interventional Therapy, The First Affiliated Hospital, Xiamen, Fujian (China); Hu, Li-Bao [Peking University People' s Hospital, Department of Radiology, Beijing (China)

    2015-09-15

    To describe and assess the localization of small peripheral pulmonary nodules prior to video-assisted thoracoscopic surgical (VATS) resection using the implantation of microcoils. Ninety-two patients with 101 pulmonary nodules underwent computed tomography (CT)-guided implantation of microcoils proximal to each nodule. Patients were randomly assigned to undergo entire microcoil or leaving-microcoil-end implantations. The complications and efficacy of the two implantation methods were evaluated. VATS resection of lung tissue containing each pulmonary lesion and microcoil were performed in the direction of the microcoil marker. Histopathological analysis was performed for the resected pulmonary lesions. CT-guided microcoil implantation was successful in 99/101 cases, and the placement of microcoils within 1 cm of the nodules was not disruptive. There was no difference in the complications and efficacy associated with the entire implantation method (performed for 51/99 nodules) versus the leaving-microcoil-end implantation method (performed for 48/99 nodules). All nodules were successfully removed using VATS resection. Asymptomatic pneumothorax occurred in 16 patients and mild pulmonary haemorrhage occurred in nine patients. However, none of these patients required further surgical treatment. Preoperative localization of small pulmonary nodules using a refined percutaneous microcoil implantation method was found to be safe and useful prior to VATS resection. (orig.)

  5. CT-guided resection of pulmonary metastases; CT-gesteuerte Resektion pulmonaler Metastasen

    Energy Technology Data Exchange (ETDEWEB)

    Gaffke, G.; Stroszczynski, C.; Felix, R. [Klinik fuer Strahlenheilkunde, Charite, Campus Rudolf-Virchow-Klinikum, Berlin (Germany); Rau, B.; Liebeskind, U.; Huenerbein, M.; Bayraktar, S.; Schlag, P.M. [Chirurgie und Chirurgische Onkologie, Charite, Helios-Klinikum Campus Buch, Robert-Roessle-Klinik, Berlin (Germany)

    2005-06-01

    Purpose: to evaluate the feasibility and potential use of intraoperative computed tomography (IOP CT) as guidance for video-assisted thoracic surgery (VATS). Material and methods: fifteen consecutive patients with peripheral intrapulmonary nodules underwent a thoracoscopy with IOP CT. Solitary lesions were known in 6/15 patients (40%, group II) whereas 9/15 (60%, group I) patients had multiple lesions (n {>=} 2). IOP CT was performed with the mobile CT scanner Philips Tomoscan M. Radiologists intraoperatively placed percutaneous marks of lung lesions after unsuccessful VATS by use of a lung marker set (Somatex, Teltow, Germany). VATS was performed under general anaesthesia and with double lumen endotracheal intubation for single lung ventilation. Imaging quality and imaging of pulmonary nodules were rated. Results: IOP CT was evaluated as feasible combined with VATS. Thoracotomy was avoided in 5/15 patients where lesions could not be detected by VATS. A CT-guided biopsy was performed in two patients after an unsuccessful attempt of thoracoscopy. There were no documented side effects. Conclusion: first clinical results suggest that a combination of VATS and IOP CT is feasible. Thus, the number of open thoracoscopies might be decreased. Intrapulmonary lesions not detectable with VATS could be marked under CT - guidance intraoperatively and then resected by thoracoscopy. (orig.)

  6. Hyaluronic Acid Gel Injection to Prevent Thermal Injury of Adjacent Gastrointestinal Tract during Percutaneous Liver Radiofrequency Ablation

    Energy Technology Data Exchange (ETDEWEB)

    Hasegawa, Takaaki, E-mail: hasegawat@clin.medic.mie-u.ac.jp; Takaki, Haruyuki; Miyagi, Hideki; Nakatsuka, Atsuhiro; Uraki, Junji; Yamanaka, Takashi; Fujimori, Masashi; Sakuma, Hajime; Yamakado, Koichiro [Mie University School of Medicine, Department of Radiology (Japan)

    2013-08-01

    This study evaluated the safety, feasibility, and clinical utility of hyaluronic acid gel injection to separate the gastrointestinal tract from the tumor during liver radiofrequency ablation (RFA). Eleven patients with liver tumors measuring 0.9-3.5 cm (mean {+-} standard deviation, 2.1 {+-} 0.8 cm) that were adjacent to the gastrointestinal tracts received RFA after the mixture of hyaluronic acid gel and contrast material (volume, 26.4 {+-} 14.5 mL; range, 10-60 mL) was injected between the tumor and the gastrointestinal tract under computed tomographic-fluoroscopic guidance. Each tumor was separated from the gastrointestinal tract by 1.0-1.5 cm (distance, 1.2 {+-} 0.2 cm) after injection of hyaluronic acid gel, and subsequent RFA was performed without any complications in all patients. Although tumor enhancement disappeared in all patients, local tumor progression was found in a patient (9.1 %, 1 of 11) during the follow-up of 5.5 {+-} 3.2 months (range, 0.4-9.9 months). In conclusion, hyaluronic acid gel injection is a safe and useful technique to avoid thermal injury of the adjacent gastrointestinal tract during liver RFA.

  7. Treatment of liver cancer of middle and advanced stages using ultrasound-guided percutaneous ethanol injection combined with radiofrequency ablation: A clinical analysis

    Science.gov (United States)

    SUN, XUE; LI, RU; ZHANG, BOTAO; YANG, YUEJIE; CUI, ZHIFEI

    2016-01-01

    Liver cancer is a malignancy of the digestive system and has a high morbidity and mortality rate. Local intervention has become a viable option in identifying liver treatment. The aim of the present study was to analyze the clinical effects of treating liver cancer in middle and advanced stages using ultrasound-guided percutaneous ethanol injection (PEI) in tumors combined with radiofrequency ablation (RFA). A total of 100 patients with stage III–IV liver cancers were selected to participate in the study. Patients were divided into groups. In group A, treatment was initiated with PEI and after 1–2 weeks RFA was applied while in group B treatment was initiated with RFA and after 1–2 weeks PEI was applied. Patients in group C received PEI and RFA simultaneously. The clinical effects in the 3 groups were compared after 6-month follow ups. The volume of tumor ablation necrosis in group A was significantly greater than that in the groups B and C, while the size was significantly smaller compared to groups B and C after ablation. For group A, the complete ablation rate was significantly higher than that in groups B and C, and the differences were statistically significant (P<0.05). Liver damage indices, including raising levels of glutamic-pyruvic transaminase and total bilirubin, were significantly decreased in group A (P<0.05). The survival rate in group A was also significantly higher than in groups B and C (P<0.05). In conclusion, for patients with liver cancer in middle and advanced stages, the treatment method using PEI followed by RFA was more beneficial in terms of improving the tumor ablation rate, alleviating liver damages and increasing survival rates. PMID:26998128

  8. Percutaneous radiofrequency lesions adjacent to the dorsal root ganglion alleviate spasticity and pain in children with cerebral palsy: pilot study in 17 patients

    Directory of Open Access Journals (Sweden)

    van Rhijn Lodewijk W

    2010-06-01

    Full Text Available Abstract Background Cerebral palsy (CP may cause severe spasticity, requiring neurosurgical procedures. The most common neurosurgical procedures are continuous infusion of intrathecal baclofen and selective dorsal rhizotomy. Both are invasive and complex procedures. We hypothesized that a percutaneous radiofrequency lesion of the dorsal root ganglion (RF-DRG could be a simple and safe alternative treatment. We undertook a pilot study to test this hypothesis. Methods We performed an RF-DRG procedure in 17 consecutive CP patients with severe hip flexor/adductor spasms accompanied by pain or care-giving difficulties. Six children were systematically evaluated at baseline, and 1 month and 6 months after treatment by means of the Modified Ashworth Scale (MAS, Gross Motor Function Measure (GMFM and a self-made caregiver's questionnaire. Eleven subsequent children were evaluated using a Visual Analogue Scale (VAS for spasticity, pain and ease of care. Results A total of 19 RF-DRG treatments were performed in 17 patients. We found a small improvement in muscle tone measured by MAS, but no effect on the GMFM scale. Despite this, the caregivers of these six treated children unanimously stated that the quality of life of their children had indeed improved after the RF-DRG. In the subsequent 11 children we found improvements in all VAS scores, in a range comparable to the conventional treatment options. Conclusion RF-DRG is a promising new treatment option for severe spasticity in CP patients, and its definitive effectiveness remains to be defined in a randomised controlled trial.

  9. Complication rates of CT-guided transthoracic lung biopsy : meta-analysis

    NARCIS (Netherlands)

    Heerink, W J; de Bock, G H; de Jonge, G J; Groen, H J M; Vliegenthart, R; Oudkerk, M

    2016-01-01

    OBJECTIVES: To meta-analyze complication rate in computed tomography (CT)-guided transthoracic lung biopsy and associated risk factors. METHODS: Four databases were searched from 1/2000 to 8/2015 for studies reporting complications in CT-guided lung biopsy. Overall and major complication rates were

  10. Complication rates of CT-guided transthoracic lung biopsy : meta-analysis

    NARCIS (Netherlands)

    Heerink, W. J.; de Bock, G. H.; de Jonge, G. J.; Groen, H. J. M.; Vliegenthart, R.; Oudkerk, M.

    2017-01-01

    To meta-analyze complication rate in computed tomography (CT)-guided transthoracic lung biopsy and associated risk factors. Four databases were searched from 1/2000 to 8/2015 for studies reporting complications in CT-guided lung biopsy. Overall and major complication rates were pooled and compared b

  11. Percutaneous epidural drainage through a burr hole

    Directory of Open Access Journals (Sweden)

    Priscila M Falsarella

    2016-01-01

    Full Text Available Intracranial extradural collection may cause an increase in intracranial pressure, requiring rapid emergency treatment to reduce morbidity and mortality. We described an alternative CT-guided percutaneous access for extradural collection drainage. We report a case of a patient with previous craniectomy for meningioma ressection who presented to the Emergency Department with symptoms of intracranial hypertension. Brains CT showed a extradural collection with subfalcine herniation. After multidisciplinary discussion a CT-guided percutaneous drainage through previous burr hole was performed. The patient was discharged after 36 hours of admission, without further symptoms. We describe a safe and effective alternative percutaneous access for extradural collection drainage in patients with previous burr hole.

  12. Percutaneous Catheter Drainage of Periappendiceal abscess due to Appendicolith : A case report

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Dae Sik; Kim, Heung Chueol; Han, Tae Kyun; Hur, Hun; Yum, Kung Tae; Namkung, Sook; Park, Man Soo; Hwang, Woo Chueol [Hallym University College of Medicine, Chuncheon (Korea, Republic of)

    1996-12-15

    Percutaneous catheter drainage of periappendiceal abscess is an effective and safe method of treatment. It is known that CT guided approach is the first choice of method. We experienced a successful percutaneous catheter drainage under ultrasound guidance for periappendiceal abscess with appendicolith

  13. Percutaneous drainage in the treatment of emphysematous pyelonephritis: 10-year experience

    Energy Technology Data Exchange (ETDEWEB)

    Chen, M.; Huang, C.; Chou, Y.; Huang, Ch.; Chiang, C.; Liu, G. [Chung-Ho Memorial Hospital, Kaohsiung Medical College, Taiwan (China)

    1997-11-01

    CT is an efficient imaging method for diagnosis, guiding the drainage procedures and monitoring response to percutaneous drainage of emphysematous pyelonephritis. Antibiotic therapy combined with CT guided percutaneous drainage of emphysematous pyelonephritis is an acceptable alternative to antibiotic therapy with surgical intervention. (authors)

  14. Discussion on the risking factors of pneumothorax complicated by CT guided percutaneous lung biopsy in elderly pa-tients with long-term hospitalization%长期住院老年患者采取CT引导下经皮肺穿刺并发气胸的危险因素探讨

    Institute of Scientific and Technical Information of China (English)

    苗振伟; 张福刚; 陈振岗; 李文贵

    2014-01-01

    目的:分析在CT引导下行经皮肺穿刺的老年长期住院患者发生气胸的危险因素。方法选取我院行CT引导下经皮肺穿刺检查的长期住院老年患者130例,其中90例患者(对照组)未采用术后快速翻转患者体位技术;40例患者(实验组)采用术后快速翻转患者体位技术。分析总结两组患者并发气胸的发生率及临床资料,探讨导致患者发生气胸的危险因素。结果对照组患者气胸合并症发生率(36.7%)与实验组患者气胸合并症发生率(17.5%)的差异有统计学意义(P30min、穿刺角度>30°、穿刺次数>3次、病灶大小5cm及合并病灶周围肺气肿均为并发气胸的危险因素(P0.05). The inci-dence rate of pneumothorax in two groups had significant difference (P<0.05). Multiple factor of Logistic analysis for control group showed:puncture time was over 30min,puncture angle was over 30°, the number of puncture was over 3,the size of the lesions was over 3cm, the depth of lesion was over 5cm, emphysema around the lesions were the risking factors for pneumothorax (P<0.05). In experiment group, Mean rapid needle-out patient-rollover time was(12.3±5.1)s,70%patients (28/40) achieved a needle-out patient-rollover time of 12.3s or less. No risking factors for pneumothorax were identified in experiment group. Conclusion Percutaneous lung puncture under CT in elderly patients with long-term hospitalization should pay attention to the above risking factors in order to avoid complicated pneumothorax. Patients with postoperative should be assisted rollover to the puncture point downward position as soon as possible, it can reduce the incidence rate of pneumothorax. Use of this technique can attenuate the influence of traditional risking factors for pneumothorax.

  15. Percutaneous target radiofrequency thermocoagulation combined with ozone ablation in treatment of lum-bar disc herniation%经皮靶点射频热凝联合臭氧消融治疗腰椎间盘突出症

    Institute of Scientific and Technical Information of China (English)

    童迅; 秦小虎; 孙凌梅; 彭文娟; 吕客; 宋一平

    2015-01-01

    Objective To study the recent efficacy of percutaneous target radiofrequency thermocoagulation combined with o-zone ablation in treatment of lumbar disc herniation.Methods 152 patients with lumbar disc herniation were treated with percutane-ous target radiofrequency thermocoagulation combined with ozone ablation from August 2012 to December 2013.The clinical efficacy was analyzed.Results All patients were followed up from 3 months to 6 months.At Macnab low back pain assessment standards, ex-cellent in 88 cases, good in 35 cases, improved in 19 cases, poor in 10 cases, the total effective rate was 93.4%.Conclusion The recent efficacy of percutaneous target radiofrequency thermocoagulation combined with ozone ablation in treatment of lumbar disc hernia-tion was satisfactory, which is a preferred method of treatment of lumbar disc herniation.%目的:分析经皮靶点射频热凝联合臭氧消融治疗腰椎间盘突出症的近期疗效。方法2012年8月-2013年12月采用经皮靶点射频热凝联合臭氧消融治疗腰椎间盘突出症152例,对其临床疗效进行分析。结果152例均获随访,时间3~6个月,按Macnab腰腿痛手术评价标准进行评定,优88例,良35例,可19例,差10例,总有效率达93.4%。结论经皮靶点射频热凝联合臭氧消融治疗腰椎间盘突出症的近期疗效满意,是一种治疗腰椎间盘突出症的较好方法。

  16. Efficacy and Potential MicroRNA Mechanism for Computed Tomography-Guided Percutaneous Radiofrequency Ablation of Primary Lung Cancer and Lung Metastasis from Liver Cancer

    Directory of Open Access Journals (Sweden)

    Xun Hu

    2014-04-01

    Full Text Available Background: The aim of this study was to evaluate comparatively the effectiveness of computed tomography-guided percutaneous radiofrequency ablation (CT-PRFA for primary non-small cell lung cancer (NSCLC and lung metastases from hepatocellular carcinoma (HCC and to explore the potential miRNA mechanisms for the efficacy of CT-PRFA. Methods: 14 patients pathologically diagnosed with NSCLC and 12 patients with lung metastases from HCC were enrolled in the study and underwent CT-PRFA. Clinical outcomes were compiled on the basis of review of medical records, imaging follow-up reports, and any biopsy-proved residual or recurrent disease. Real-time RT-PCR was used to quantify the selected miRNAs known to be play key roles in lung cancer. Results: A total of 21 tumors were treated with umbrella-tip electrodes and spiral-tip electrodes were used for the remaining 8 tumors. The median follow-up was 13.5 months (range, 3-30 months and no patient was lost to follow-up. The rate of technique efficacy for primary tumors was ∼93% (13 of 14. Treatment was successful in 11 out of 12 (91.7% lung metastases patients. Overall survival rate was 80.8% at 2 years, and cancer-specific survival rate was 100% at 2 years. The tumor-free survival was 69.2% at 1 year and 26.9% at 2 years. Before PRFA, tumor suppressor let-7a and miR-34a were downregulated whereas oncomiR miR-21 was upregulated in primary tumors, and let-7a and miR-126 levels were downregulated whereas oncomiRs miR-21, miR-155 and miR-17-5p/miR-20b levels were upregulated in secondary tumors. This abnormal expression was normalized by CT-PRFA. Most notably, CT-PRFA failed to normalize the deregulated miRNAs in the non-survivors. Conclusions: CT-PRFA is a effective treatment for primary NSCLCs and secondary lung tumors from HCC and the efficacy may be related to its ability to normalize deregulated expression of miRNAs: upregulating tumor suppressor miRNAs and downregulating oncomiRs.

  17. CT引导下胰腺坏死组织感染经皮穿刺置管引流失败危险因素分析%Risk factors for failure of CT guided percutaneous catheter drainage for infective pancreatic necrosis

    Institute of Scientific and Technical Information of China (English)

    曾彦博; 陈燕; 董元航; 王凯旋; 杜奕奇; 李兆申

    2015-01-01

    目的 探讨CT引导下胰腺坏死组织感染(IPN)应用经皮穿刺置管引流(PCD)治疗的相关危险因素.方法 回顾性分析2010年4月至2014年6月长海医院胰腺重症监护病房收治的胰腺坏死组织感染经PCD治疗的60例患者病历资料.将患者分成PCD成功组(48例)及PCD失败组(12例),记录可能引起PCD失败的各项参数,包括患者的性别、年龄、病因、住院时间、转归;入院后MCTSI、APACHEⅡ评分、发生器官功能衰竭的脏器数量、抗生素应用天数、质子泵抑制剂应用天数、液体复苏是否延迟、开始应用肠内营养的时间、营养状况等,并通过单因素及多因素Logistic回归法进行分析.结果 单因素分析结果显示,MCTSI评分、器官功能衰竭的数量、营养不良、服用质子泵抑制剂、延迟空肠营养、延迟液体复苏、引流管的数量、穿刺次数、引流液多重耐药菌感染等是引起PCD失败的危险因素;多因素分析结果显示,MCTSI(OR=3.33,95% CI 1.52~7.29;P=0.003)、引流液多重耐药菌感染(OR=8.62,95% CI 1.11 ~67.19,P=0.040)是引起PCD失败的独立危险因素.结论 MCTSI评分及引流液多重耐药菌感染会影响PCD的成功率.MCTSI评分高、引流液多重耐药菌感染的IPN患者应慎重应用PCD治疗.%Objective To investigate the risk factors for failure of percutaneous catheter drainage (PCD) for patients with infective pancreatic necrosis (IPN).Methods A retrospective review of medical records of patients with IPN who received PCD at Pancreatic Intensive Care Unit (PICU) of Changhai Hospital from April 2010 to June 2014 was performed.The patients were divided into 2 groups:(1) PCD success group (n =48) and (2) PCD failure group (n =12).The potential parameters for failure of PCD were recorded,which included age,sex,etiology,length of hospital stay,outcome,MCTSI,APACHE Ⅱ scores,number of organ failure,duration of use of antibiotics,duration of use of PPIs,if delayed

  18. Effectiveness of combined use of imprint cytological and histological examination in CT-guided tissue-core biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Yamagami, Takuji; Yoshimatsu, Rika; Kajiwara, Kenji; Ishikawa, Masaki; Awai, Kazuo [Hiroshima University, Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Minami-Ku, Hiroshima (Japan); Matsumoto, Tomohiro; Hasebe, Terumitsu [Tokai University Hachioji Hospital, Tokai University School of Medicine, Department of Radiology, Hachioji, Tokyo (Japan); Kakizawa, Hideaki [Hiroshima University, Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Minami-Ku, Hiroshima (Japan); Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Department of Diagnostic Radiology, Naka-Ku, Hiroshima (Japan); Toyoda, Naoyuki [Hiroshima University, Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Minami-Ku, Hiroshima (Japan); National Hospital Organisation Kure Medical Centre, Department of Diagnostic Radiology, Kure, Hiroshima (Japan)

    2014-05-15

    This study evaluated the efficacy of the combination of imprint cytology and histology in tissue-core percutaneous biopsy under real-time computed tomography (CT) fluoroscopic guidance. Between October 2009 and June 2013, 156 percutaneous needle biopsies were performed in our institution. Those obtained by tissue-core biopsy underwent both imprint cytological and histological examinations routinely after touch imprint cytology was performed on site to evaluate the samples' sufficiency for cytological and pathological examination. Final diagnosis was confirmed by independent surgical pathology, independent culture results or clinical follow-up. Rates of adequate specimens and precise diagnosis, by combined cytological and histological examination were 100 % (156/156) and 96.2 % (150/156), by cytology 94.4 % (152/156) and 83.3 % (130/156) and by histology 99.3 % (155/156) and 92.3 % (144/156). Precise diagnosis was achieved by combined examinations in 94.7 % (89/94) of thoracic lesions, 97.6 % (40/41) of musculoskeletal lesions, and 100 % (21/21) of abdominal, pelvic and retroperitoneal lesions. In all 104 lesions diagnosed as malignant by CT-guided biopsy and in 30 of 52 diagnosed as benign, specific cell types could be proved by combined examinations. Combined imprint cytology and histology performed after on-site touch imprint cytological evaluation improved the diagnostic ability of CT fluoroscopically guided biopsy. (orig.)

  19. The optimal radiofrequency temperature in radiofrequency thermocoagulation for idiopathic trigeminal neuralgia

    Science.gov (United States)

    Tang, Yuan-Zhang; Yang, Li-Qiang; Yue, Jian-Ning; Wang, Xiao-Ping; HE, Liang-Liang; NI, Jia-Xiang

    2016-01-01

    Abstract Objective: Our previous study evaluated the effectiveness and safety of radiofrequency thermocoagulation (RFT) of trigeminal gasserian ganglion for idiopathic trigeminal neuralgia (ITN). The aim of this study was to evaluate the optimal radiofrequency temperature of computed tomography (CT)-guided RFT for treatment of ITN. Methods: A retrospective study of patients with ITN treated with a single CT-guided RFT procedure between January 2002 and December 2013. Patients were divided into ≤75 °C, 75 °C, and ≥80 °C groups according to the highest radiofrequency temperature used. Pain relief was graded from poor to excellent, and facial numbness/dysesthesia from I (absent) to IV (most severe). Results: A total of 1161 RFT procedures were undertaken in the 1137 patients. The mean follow-up time was 46 ± 31 months. There were no significant differences in the rate of excellent pain relief according to the radiofrequency temperature used. However, more patients experienced with no facial numbness or facial numbness gradually resolved and those patients treated at 75 °C had a lower rate of grade IV facial numbness/dysesthesia than other groups. Conclusions: The optimal radiofrequency temperature to maximize pain relief and minimize facial numbness or dysesthesia may be 75 °C, but this requires confirmation. PMID:27428194

  20. Percutaneous local therapies for hepatocellular carcinoma impair gastric function

    Institute of Scientific and Technical Information of China (English)

    Fumihiko Kinekawa; Shigeki Kuriyama; Kazuya Matsuda; Tsutomu Masaki; Kazutaka Kurokohchi; Hirohito Yoneyama; Hideyuki Inoue; Hirohide Kurata; Yoshihito Uchida; Seishiro Watanabe

    2006-01-01

    @@ TO THE EDITOR Percutaneous local therapies, such as percutaneous ethanol injection (PEI), microwave coagulation and radiofrequency ablation (RFA), are frequently used worldwide for the treatment of hepatocellular carcinoma (HCC) because of their high effectiveness.

  1. CT-guided Perineural Injections for Chronic Pelvic Pain.

    Science.gov (United States)

    Wadhwa, Vibhor; Scott, Kelly M; Rozen, Shai; Starr, Adam J; Chhabra, Avneesh

    2016-01-01

    Chronic pelvic pain is a disabling condition that affects a large number of men and women. It may occur after a known inciting event, or it could be idiopathic. A common cause of pelvic pain syndrome is neuropathy of the pelvic nerves, including the femoral and genitofemoral nerves, ilioinguinal and iliohypogastric nerves, pudendal nerve, obturator nerve, lateral and posterior femoral cutaneous nerves, inferior cluneal nerves, inferior rectal nerve, sciatic nerve, superior gluteal nerve, and the spinal nerve roots. Pelvic neuropathy may result from entrapment, trauma, inflammation, or compression or may be iatrogenic, secondary to surgical procedures. Imaging-guided nerve blocks can be used for diagnostic and therapeutic management of pelvic neuropathies. Ultrasonography (US)-guided injections are useful for superficial locations; however, there can be limitations with US, such as its operator dependence, the required skill, and the difficulty in depicting various superficial and deep pelvic nerves. Magnetic resonance (MR) imaging-guided injections are radiation free and lead to easy depiction of the nerve because of the superior soft-tissue contrast; although the expense, the required skill, and the limited availability of MR imaging are major hindrances to its widespread use for this purpose. Computed tomography (CT)-guided injections are becoming popular because of the wide availability of CT scanners, the lower cost, and the shorter amount of time required to perform these injections. This article outlines the technique of perineural injection of major pelvic nerves, illustrates the different target sites with representative case examples, and discusses the pitfalls. (©)RSNA, 2016.

  2. Therapy of HCC-radiofrequency ablation.

    Science.gov (United States)

    Buscarini, L; Buscarini, E

    2001-01-01

    Radiofrequency interstitial hyperthermia has been used for percutaneous ablation of hepatocellular carcinoma, under ultrasound guidance in local anesthesia. Conventional needle electrodes require a mean number of 3 sessions to treat tumors of diameter hemotorax in one case; a fluid collection in the site of ablated tumor in one patient treated by combination of transcatheter arterial embolization and radiofrequency application.

  3. THREE-DIMENSIONAL COMPUTED TOMOGRAPHY-GUIDED RADIOFREQUENCY TRIGEMINAL RHIZOTOMY FOR TREATMENT OF IDIOPATHIC TRIGEMINAL NEURALGIA

    Institute of Scientific and Technical Information of China (English)

    Meng Liu; Cheng-yuan Wu; Yu-guang Liu; Hong-wei Wang; Fan-gang Meng

    2005-01-01

    Objective To evaluate the effectiveness of three-dimensional computed tomography (3D-CT) guided radiofrequency trige minal rhizotomy (RF-TR) in treatment of idiopathic trigeminal neuralgia (ITN). Methods From 1999 to 2001, 18 patients with ITN were treated with percutaneous controlled RF-TR. Intraoperative 3D-CT scanning was performed to guide the trajectory of the puncture. After correction of the needle tip according to the CT scans and stimulation effects, 2 to 5 lesions were made for a duration of 60-90 seconds at a temperature of 60℃ to 75℃ depend ing on the pain distribution and the age of patient. Results The needles located in foramen ovale. Pain alleviated immediately with no serious complication in all patients. The patients were followed up for an average of 31.5 months (range 24-41 months). Acute pain relief was experienced by 17 patients after the procedure, reaching an initial success rate of 94.4%. Early (< 6 months) pain recurrence was observed in 2 patients (11.1%), whereas late (> 6 months) recurrence was reported in 3 patients (16.7%). Thirteen patients had complete pain control, with no need for medication thereafter. Five cases experienced partial pain relief, but required medication at a lower dose than in the preoperative period. Conclusion 3D-CT foramen ovale locations can raise the successful rate of puncture, enhance the safety, and reduce the incidence rate of complication.

  4. Curved Needles in CT-Guided Fine Needle Biopsies of Abdominal and Retroperitoneal Small Lesions.

    Science.gov (United States)

    De Filippo, Massimo; Saba, Luca; Rossi, Enrica; Nizzoli, Rita; Tiseo, Marcello; Pedrazzi, Giuseppe; Brunese, Luca; Rotondo, Antonio; Rossi, Cristina

    2015-12-01

    To demonstrate the advantages of using curved needles in fine needle aspiration (FNA) with CT-guided, for analyzing abdominal and/or retroperitoneal small lesions which are impossible to reach with conventional non-surgical biopsy techniques, particularly in cases in which the cytology sample was not possible to obtain by means of US or CT guide with axial images. An authorization for CT-guided FNA in patients with neoplasms is not required by the institutional review board of our Institute. From April 2012 to November 2014, the study included retrospectively 25 patients (16 M, 9 F) who underwent CT-guided FNA of abdominal and/or retroperitoneal small lesions (biopsy procedure because of the interposition of anatomical obstacles. Patients with suspected lymphomas or sarcomas, pediatric patients and patients with bleeding diathesis were excluded. Cytology reports were used for evaluating suitability. The biological material was considered to be suitable for cytological study, with a diagnostic value in all 25 cases, finding in particular: out of 23 neoplastic lesions (85%), 21 were malignant (90.2%) and 2 were benign (8%). 2 out 25 were non-neoplastic benign lesions (8%). No procedural complications arose in any of the cases (0%). Using curved needles, there is an effective improvement in CT-guided FNA of abdominal and retroperitoneal small lesions which are difficult to achieve with conventional CT or ultrasound guide.

  5. Pediatric Percutaneous Osteoid Osteoma Ablation: Cone-Beam CT with Fluoroscopic Overlay Versus Conventional CT Guidance.

    Science.gov (United States)

    Perry, Brandon C; Monroe, Eric J; McKay, Tyler; Kanal, Kalpana M; Shivaram, Giridhar

    2017-05-11

    To compare technical success, clinical success, complications, radiation dose, and total room utilization time for osteoid osteoma thermal (radiofrequency or microwave) ablation using cone-beam computed tomography (CBCT) with two-axis fluoroscopic navigational overlay versus conventional computed tomography (CT) guidance. A retrospective review was performed to identify all osteoid osteoma ablations performed over a 5.5-year period at a single tertiary care pediatric hospital. Twenty-five ablations (15 radiofrequency and 10 microwave) in 23 patients undergoing fluoroscopic CBCT-guided osteoid osteoma ablation were compared to 35 ablations (35 radiofrequency) in 32 patients undergoing ablation via conventional CT guidance. Dose area product and dose length product were recorded for CBCT and conventional CT, respectively, and converted to effective doses. Technical success, clinical success (cessation of pain and medication use 1 month after ablation), complications, radiation dose, and total room utilization time were compared. All procedures were technically successful. Twenty-two of 25 (88.0%) CBCT and 31 of 35 (88.6%) conventional CT-guided ablations achieved immediate clinical success. There were two minor complications in each group and no major complications. Mean effective radiation dose was significantly lower for CBCT compared to CT guidance (0.12 vs. 0.39 mSv, p = 0.02). Mean total room utilization time for CBCT was longer (133.5 vs. 97.5 min, p = 0.0001). Fluoroscopic CBCT guidance for percutaneous osteoid osteoma ablation yields similar technical and clinical success, reduced radiation dose, and increased total room utilization time compared to conventional CT guidance.

  6. Radiofrequency (thermal) ablation versus no intervention or other interventions for hepatocellular carcinoma

    DEFF Research Database (Denmark)

    Weis, Sebastian; Franke, Annegret; Mössner, Joachim

    2013-01-01

    Hepatocellular carcinoma is the fifth most common cancer worldwide. Percutaneous interventional therapies, such as radiofrequency (thermal) ablation (RFA), have been developed for early hepatocellular carcinoma. RFA competes with other interventional techniques such as percutaneous ethanol...

  7. Radiation dose associated with CT-guided drain placement for pediatric patients

    Energy Technology Data Exchange (ETDEWEB)

    Schwartz, Cody J.; Isaacson, Ari J.; Fordham, Lynn Ansley; Ivanovic, Marija; Dixon, Robert G. [University of North Carolina at Chapel Hill, Department of Radiology, UNC Health Care, Chapel Hill, NC (United States); Taylor, J.B. [University of North Carolina at Chapel Hill, Environment, Health and Safety, Chapel Hill, NC (United States)

    2017-05-15

    To date, there are limited radiation dose data on CT-guided procedures in pediatric patients. Our goal was to quantify the radiation dose associated with pediatric CT-guided drain placement and follow-up drain evaluations in order to estimate effective dose. We searched the electronic medical record and picture archiving and communication system (PACS) to identify all pediatric (<18 years old) CT-guided drain placements performed between January 2008 and December 2013 at our institution. We compiled patient data and radiation dose information from CT-guided drain placements as well as pre-procedural diagnostic CTs and post-procedural follow-up fluoroscopic abscess catheter injections (sinograms). Then we converted dose-length product, fluoroscopy time and number of acquisitions to effective doses using Monte Carlo simulations and age-appropriate conversion factors based on annual quality-control testing. Fifty-two drainages were identified with mean patient age of 11.0 years (5 weeks to 17 years). Most children had diagnoses of appendicitis (n=23) or inflammatory bowel disease (n=11). Forty-seven patients had diagnostic CTs, with a mean effective dose of 7.3 mSv (range 1.1-25.5 mSv). Drains remained in place for an average of 16.9 days (range 0-75 days), with an average of 0.9 (0-5) sinograms per patient in follow-up. The mean effective dose for all drainages and follow-up exams was 5.3 mSv (0.7-17.1) and 62% (32/52) of the children had effective doses less than 5 mSv. The majority of pediatric patients who have undergone CT-guided drain placements at our institution have received total radiation doses on par with diagnostic ranges. This information could be useful when describing the dose of radiation to parents and providers when CT-guided drain placement is necessary. (orig.)

  8. Percutaneous Ultrasound-Guided TOPAZ Radiofrequency Coblation: A Novel Coaxial Technique for the Treatment of Recalcitrant Plantar Fasciitis-Our Experience.

    Science.gov (United States)

    Shah, Amit; Best, Alistair J; Rennie, Winston J

    2016-06-01

    Various therapeutic options are available for treatment of recalcitrant plantar fasciitis. Studies using TOPAZ coblation (ArthroCare, Sunnyvale, CA) have had good early results. The current coblation technique involves a surgical incision or breach of the highly specialized plantar fat pad, which can be associated with risks. We describe a novel technique of ultrasound-guided percutaneous coblation with a lateral heel approach. Advantages include precise targeting of the plantar fascia by direct dynamic visualization of the coblation tip, a true percutaneous approach with a needle skin puncture (<5 mm), and preservation of the plantar fat pad by using a lateral heel approach.

  9. 经皮穿刺手动调压脉冲射频模式治疗颈椎间盘突出症%THE CLINICAL EFFECTS OF PERCUTANEOUS PUNCTURE MANUAL VOLTAGE REGULATION PULSED RADIOFREQUENCY MODE ON CERVICAL DISC HERNIATION

    Institute of Scientific and Technical Information of China (English)

    吴大胜; 刘娜; 宫小文; 宋永光

    2012-01-01

    Objective: To evaluate the clinical effects of percutaneous puncture manual voltage regulation pulsed radiofrequency mode on the treatment cervical disc herniation. Methods: From August 2010 to September 2011, 112 patients with cervical disc herniation were given with percutaneous puncture manual voltage regulation pulsed radiofrequency mode guided through C arm X-ray machine, CT or DSA. The visual analogue scale (VAS) score and clinical effects were recorded before and after treatment. Results: After 3 d the treatment, the excellent cases were 96, the good cases were 14, and the bad cases were 2, the excellent and good rate was 98.2%. There were 2 bad cases because the doctor failed to grasp the good indication. Compared with pre-operation (7.8 ± 0.4), the VAS at 3 d after operation (1.5 ± 0.3) was decreased (P < 0.05). Conclusion: Percutaneous puncture manual voltage regulation pulsed radiofrequency mode therapy is a suitable treatment for cervical disc herniation, with the advantages of simple operation, easy to master, small trauma, not influencing the stability of spine biomechanics, no serious complications.%目的:评估手动调压脉冲射频模式治疗颈椎间盘突出症的临床可行性.方法:2010年8月~2011年9月,112例颈椎间盘突出症患者,在C型臂X线机、CT或DSA引导下接受经皮穿刺手动调压脉冲射频模式治疗.观察并记录术前后的视觉模拟评分(visual analogue scale,VAS),并进行疗效评估.结果:本组112例患者,经过该技术治疗后3d,其中96例治疗效果达优级,14例治疗效果良好,2例效果差,优良率98.2%.其中,效果较差的2例是因为未把握好适应症.与术前VAS评分(7.8±0.4)相比,术后3天VAS评分(1.5±0.3)降低(P<0.05).结论:经皮穿刺手动调压脉冲射频模式治疗颈椎间盘突出症具有操作简单、易于掌握、创伤小、不影响脊柱生物力学稳定性、无严重并发症等特点.是一种可供临床选用的、效果确切又较

  10. Impact of delineation uncertainties on dose to organs at risk in CT-guided intracavitary brachytherapy.

    LENUS (Irish Health Repository)

    Duane, Frances K

    2014-08-07

    This study quantifies the inter- and intraobserver variations in contouring the organs at risk (OARs) in CT-guided brachytherapy (BT) for the treatment of cervical carcinoma. The dosimetric consequences are reported in accordance with the current Gynecological Groupe Européen de Curiethérapie\\/European Society for Therapeutic Radiology and Oncology guidelines.

  11. Stress-induced osteolysis of distal clavicle: imaging patterns and treatment using CT-guided injection

    Energy Technology Data Exchange (ETDEWEB)

    Sopov, V.; Groshar, D. [Dept. of Nuclear Medicine, Technion-Israel Inst. of Technology, Haifa (Israel); Fuchs, D. [Dept. of Orthopaedics, Technion-Israel Inst. of Technology, Haifa (Israel); Bar-Meir, E. [Dept. of Radiology, Technion-Israel Inst. of Technology, Haifa (Israel)

    2001-02-01

    Osteolysis of distal clavicle (ODC) may occur in patients who experience repeated stress or microtrauma to the shoulder. This entity has clinical and radiological findings similar to post-traumatic ODC. We describe a case of successful treatment of stress-induced ODC with CT-guided injection of corticosteroid and anesthetic drug into the acromioclavicular joint. (orig.)

  12. CT-guided core needle biopsy of pleural lesions: Evaluating diagnostic yield and associated complications

    Energy Technology Data Exchange (ETDEWEB)

    Niu, Xiang Ke [Dept. of Radiology, Affiliated Hospital of Chengdu University, Chengdu (China); Bhetuwal, Anup; Yang, Han Feng [Dept. of Radiology, Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong (China)

    2015-02-15

    The purpose of this study was to retrospectively evaluate the diagnostic accuracy and complications of CT-guided core needle biopsy (CT-guided CNB) of pleural lesion and the possible effects of influencing factors. From September 2007 to June 2013, 88 consecutive patients (60 men and 28 women; mean [+/- standard deviation] age, 51.1 +/- 14.4 years; range, 19-78 years) underwent CT-guided CNB, which was performed by two experienced chest radiologists in our medical center. Out of 88 cases, 56 (63%) were diagnosed as malignant, 28 (31%) as benign and 4 (5%) as indeterminate for CNB of pleural lesions. The final diagnosis was confirmed by either histopathological diagnosis or clinical follow-up. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and complication rates were statistically evaluated. Influencing factors (patient age, sex, lesion size, pleural-puncture angle, patient position, pleural effusion, and number of pleural punctures) were assessed for their effect on accuracy of CT-guided CNB using univariate and subsequent multivariate analysis. Diagnostic accuracy, sensitivity, specificity, PPV, and NPV were 89.2%, 86.1%, 100%, 100%, and 67.8%, respectively. The influencing factors had no significant effect in altering diagnostic accuracy. As far as complications were concerned, occurrence of pneumothorax was observed in 14 (16%) out of 88 patients. Multivariate analysis revealed lesion size/pleural thickening as a significant risk factor (odds ratio [OR]: 8.744, p = 0.005) for occurrence of pneumothorax. Moreover, presence of pleural effusion was noted as a significant protective factor (OR: 0.171, p = 0.037) for pneumothorax. CT-guided CNB of pleural lesion is a safe procedure with high diagnostic yield and low risk of significant complications.

  13. MRI-guided and CT-guided cervical nerve root infiltration therapy. A cost comparison

    Energy Technology Data Exchange (ETDEWEB)

    Maurer, M.H.; Froeling, V.; Roettgen, R.; Bucourt, M. de; Hamm, B.; Streitparth, F. [Charite University Medicine Berlin (Germany). Dept. of Diagnostic and Interventional Radiology; Bretschneider, T. [Magdeburg Univ. (Germany). Dept. of Radiology and Nuclear Medicine; Hartwig, T.; Disch, A.C. [Charite University Medicine Berlin (Germany). Center for Musculoskeletal Surgery

    2014-06-15

    Purpose: To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain. Materials and Methods: Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40 mg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated. Results: The mean intervention time was 24.9 min. (range: 12-36 min.) for MRI-guided infiltration and 19.7 min. (range: 5-54 min.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76. Conclusion: Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance. (orig.)

  14. CT-guided high-dose-rate brachytherapy of unresectable hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Collettini, Federico; Schreiber, Nadja; Schnapauff, Dirk; Denecke, Timm; Hamm, Bernd; Gebauer, Bernhard [ChariteUniversitaetsmedizin Berlin, Department of Diagnostic and Interventional Radiology, Berlin (Germany); Wust, Peter [ChariteUniversitaetsmedizin Berlin, Department of Radiation Oncology, Berlin (Germany); Schott, Eckart [Universitaetsmedizin Berlin, Department of Gastroenterology, Berlin (Germany)

    2015-05-01

    The purpose of the present study was to evaluate the clinical outcome of CT-guided high-dose-rate brachytherapy (CT-HDRBT) in patients with unresectable hepatocellular carcinoma (HCC). Over a 6-year period, 98 patients with 212 unresectable HCC underwent CT-HDRBT applying a {sup 192}Ir source at our institution. Magnetic resonance imaging (MRI) follow-up was performed 6 weeks after the intervention and then every 3 months. The primary endpoint was local tumor control (LTC); secondary endpoints included progression-free survival (PFS) and overall survival (OS). Patients were available for MRI evaluation for a mean follow-up of 23.1 months (range 4-64 months; median 20 months). Mean tumor diameter was 5 cm (range 1.8-12 cm). Eighteen of 212 (8.5 %) tumors showed local progression after a mean LTC of 21.1 months. In all, 67 patients (68.4 %) experienced distant tumor progression. The mean PFS was 15.2 months. Forty-six patients died during the follow-up period. Median OS was 29.2 months. Actuarial 1-, 2-, and 3-year OS rates were 80, 62, and 46 %, respectively. CT-HDRBT is an effective therapy to attain local tumor control in patients with unresectable HCC. Prospective randomized studies comparing CT-HDRBT with the standard treatments like Radiofrequency ablation (RFA) and chemoembolization (TACE) are mandatory. (orig.) [German] Zweck der vorliegenden Arbeit war die Analyse der klinischen Effektivitaet der CT-gesteuerten Hochdosis-Brachytherapie (CT-HDRBT) bei Patienten mit inoperablem hepatozellulaeren Karzinom (HCC). Ueber einen Zeitraum von 6 Jahren, wurden an unserer Klinik 98 Patienten mit 212 inoperablen HCC mittels CT-HDRBT mit {sup 192}Ir behandelt. MRT-Verlaufskontrollen erfolgten 6 Wochen nach der Intervention und dann alle 3 Monate. Primaerer Endpunkt der Studie war die lokale Tumorkontrolle (LTC); sekundaere Endpunkte waren das progressionsfreie Ueberleben (PFS) und Gesamtueberleben (OS). Die mittlere Nachbeobachtungszeit betrug 23,1 Monate (Spanne 4

  15. Intraspinal lumbar juxtaarticular cyst treatment through CT-guided percutaneus induced rupture results in a favorable patient outcome

    Directory of Open Access Journals (Sweden)

    Adisa Kursumovic

    2016-11-01

    Full Text Available Juxta-articular cysts are synovial cysts originating from the facet joints or the flava ligaments. If they grow intra-spinally they can compress nervous structures and cause a variety of symptoms. Micro-neurosurgery is usually the treatment of choice. Alternatively to surgical treatment the cyst can be approached and treated with a CT guided percutaneous injection inducing rupture. After fulfilling strict selection criteria twenty patients (25% of all treated lumbar synovial cyst patients, were treated minimally invasive by this method from 2010-2016. The facet joint was punctured under CT guidance and a mixture of a local anesthetic and contrast liquid was injected until the cyst was blasted. The mean follow-up period was 1.1 years (range 2 weeks - 5 years. Fifteen of twenty procedures were successful and cyst rupture was confirmed by CTscans. Twelve of these fifteen patients experienced a significant improvement of their symptoms and needed no further intervention or surgical procedure up until now, three patients showed no clinical improvement and were treated surgically within one week after cyst rupture. In five patients it was technically not possible to rupture the cyst. These patients were treated microsurgically by cyst resection and dynamic stabilization or fusion procedures. The percutaneus rupture of juxtaarticular cysts has fewer risks and is cost effective compared to microsurgical resection. It may be an alternative to surgical treatment for a selected group of patients. However there are some limitations to the procedure though, such as difficult patient selection, unpredictable outcome or technical problems due to highly degenerated facet joints.

  16. Intraspinal Lumbar Juxtaarticular Cyst Treatment Through CT-Guided Percutaneus Induced Rupture Results in a Favorable Patient Outcome.

    Science.gov (United States)

    Kursumovic, Adisa; Bostelmann, Richard; Gollwitzer, Maria; Rath, Stefan; Steiger, Hans Jakob; Petridis, Athanasios K

    2016-10-24

    Juxta-articular cysts are synovial cysts originating from the facet joints or the flava ligaments. If they grow intra-spinally they can compress nervous structures and cause a variety of symptoms. Micro-neurosurgery is usually the treatment of choice. Alternatively to surgical treatment the cyst can be approached and treated with a CT guided percutaneous injection inducing rupture. After fulfilling strict selection criteria twenty patients (25% of all treated lumbar synovial cyst patients), were treated minimally invasive by this method from 2010-2016. The facet joint was punctured under CT guidance and a mixture of a local anesthetic and contrast liquid was injected until the cyst was blasted. The mean follow-up period was 1.1 years (range 2 weeks - 5 years). Fifteen of twenty procedures were successful and cyst rupture was confirmed by CT-scans. Twelve of these fifteen patients experienced a significant improvement of their symptoms and needed no further intervention or surgical procedure up until now, three patients showed no clinical improvement and were treated surgically within one week after cyst rupture. In five patients it was technically not possible to rupture the cyst. These patients were treated microsurgically by cyst resection and dynamic stabilization or fusion procedures. The percutaneus rupture of juxtaarticular cysts has fewer risks and is cost effective compared to microsurgical resection. It may be an alternative to surgical treatment for a selected group of patients. However there are some limitations to the procedure though, such as difficult patient selection, unpredictable outcome or technical problems due to highly degenerated facet joints.

  17. CT-guided preoperative needle localization of MRI-detected breast lesions

    Energy Technology Data Exchange (ETDEWEB)

    Giagounidis, Elektra M. E-mail: giagounjdis@online.de; Markus, Ruwe; Josef, Luetzeler; Wemer, Audretsch; Mahdi, Rezai; Bernward, Kurtz

    2001-08-01

    To assess the value of accurate preoperative CT-guided needle localization of occult breast lesions, we reviewed a total of 39 needle-directed biopsies of breast tumors in 24 women. The average age was 52.9 years (range 31-67). All lesions were nonpalpable and mammographically, as well as sonographically occult. They were solely seen on MR-images. After demonstrating the suspicious region on CT scans, a hookwire was inserted. The correct position was confirmed by a control scan. The subsequent histopathological examination showed that 28 of the lesions (71.8%) were benign, among them mastopathy, fibrosis, fibroadenoma, papilloma, intramammary lymph node, liponecrosis and epitheliosis. Eleven lesions (28%) were malignant and showed either lobular, ductal or tubular cancer. Our results endorse that CT guided needle localization is a helpful method that allows a precise surgical excision of the suspect area with the removal of a minimal amount of breast tissue.

  18. Liver CT-guided aspirative biopsies; Puncao aspirativa de figado dirigida por tomografia computadorizada

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Gilda da Cunha; Carvalho, Leda Viegas de [Hospital de Clinicas (HCFMUSP), Sao Paulo, SP (Brazil). Divisao de Anatomia Patologica; Granero, Luzete Cristina Silva [Univeridade Federal de Sao Paulo (UNIFESP), SP (Brazil); Chojniak, Rubens [Hospital A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Imagem; Morini, Sandra Regina

    1996-09-01

    Sixty-eight CT-guided aspirative biopsies of hepatic nodules were performed at A.C. Camargo Hospital, Sao Paulo, Brazil, from 1992 to 1995. The cases were distributed as follow: 44(64.7%) with a positive diagnosis for neoplastic cells, 6(8.8%) with a negative diagnosis, and 14 (20.5%) with insufficient material. Of the positive cases (primary neoplasias and metastases), the cytological diagnosis was achieved in 39 cases. There were 36 cases of carcinoma (7 hepato carcinomas, 18 adenocarcinomas, 1 small cell carcinoma and 10 cases of unspecified differentiation), 2 cases of melanoma and 1 case of melanoma and 1 case of sarcoma. The correlation with histopathological exams showed no false positive cases and concordance between cytological and histopathological diagnosis. The results demonstrate that CT-guided aspirative biopsy of hepatic nodules permits a rapid diagnosis of neoplastic lesions, especially for the evaluation of metastases. (author) 9 refs., 1 fig.

  19. Safety of 1000 CT-guided steroid injections with air used to localize the epidural space.

    Science.gov (United States)

    Chang, A; Pochert, S; Romano, C; Brook, A; Miller, T

    2011-10-01

    Historically, ESIs were performed without any imaging guidance, resulting in erroneous placement in up to 30% of injections. Fluoroscopic imaging is now used to guide most procedures. Recently, several reports have described the use of CT to guide ESIs instead of fluoroscopy. CT provides the ability to use air as contrast to localize the epidural space. This retrospective review will discuss findings in 1000 CT-guided ESIs with air localization.

  20. Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy in cavitary pulmonary lesions

    Energy Technology Data Exchange (ETDEWEB)

    Zhuang, Yi-Ping, E-mail: yipingzhuang2010@sina.com [Department of Radiology, Jiangsu Cancer Institute and Hospital, No. 42 Baiziting Road, Nanjing 210009, Jiangsu (China); Wang, Hai-Yan, E-mail: mycherishgirl@sohu.com [Department of Radiology, Jiangsu Cancer Institute and Hospital, No. 42 Baiziting Road, Nanjing 210009, Jiangsu (China); Zhang, Jin, E-mail: yari_zj@hotmail.com [Department of Radiology, Jiangsu Cancer Institute and Hospital, No. 42 Baiziting Road, Nanjing 210009, Jiangsu (China); Feng, Yong, E-mail: fengyong119@sohu.com [Department of Radiology, Jiangsu Cancer Institute and Hospital, No. 42 Baiziting Road, Nanjing 210009, Jiangsu (China); Zhang, Lei, E-mail: motozl163@163.com [Department of Radiology, Jiangsu Cancer Institute and Hospital, No. 42 Baiziting Road, Nanjing 210009, Jiangsu (China)

    2013-01-15

    Objective: CT-guided transthoracic biopsy is a well-established method in the cytologic or histologic diagnosis of pulmonary lesions. The knowledge of its diagnostic performance and complications for cavitary pulmonary lesions is limited. The purpose of this study was to determine the diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy (FNAB) in cavitary pulmonary lesions. Materials and methods: 102 consecutive patients with pulmonary cavitary lesions received CT-guided FNAB with use of an 18-gauge (n = 35) or 20-gauge (n = 67) Chiba for histology diagnosis. The sensitivity, specificity, and diagnostic accuracy of FNAB were calculated as compared with the final diagnosis. Complications associated with FNAB were observed. The diagnostic accuracy and complications were compared between patients with different lesion sizes and different cavity wall thickness. Results: The overall sensitivity, specificity, and accuracy of FNAB were 96.3%, 98.0%, and 96.1%, respectively. The sensitivity, specificity, and diagnosis accuracy in different lesion size (<2 cm vs ≥2 cm), or different cavity wall thickness (<5 mm vs ≥5 mm) were not different (P > 0.05; 0.235). More nondiagnostic sample was found in wall thickness <5 mm lesions (P = 0.017). Associated complications included pneumothorax in 9 (8.8%) patients and alveolar hemorrhage in 14 patients (13.7%) and hemoptysis in 1 patient (1%). No different rate of complications was found with regard to lesion size, wall thickness, length of the needle path and needle size (P > 0.05). Conclusion: CT-guided FNAB can be effectively ad safely used for patients with pulmonary cavitary lesions.

  1. CT-guided corticosteroid injection for solitary eosinophilic granuloma of the spine

    Energy Technology Data Exchange (ETDEWEB)

    Rimondi, Eugenio; Rossi, Giuseppe [Istituto Ortopedico Rizzoli, University of Bologna, Department of Radiology and Interventional Angiographic Radiology, Bologna (Italy); Mavrogenis, Andreas F. [Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopedics, Bologna (Italy); Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopaedics, Orthopaedic Oncology Service, Bologna (Italy); Ussia, Giuseppe; Angelini, Andrea [Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopedics, Bologna (Italy); Ruggieri, Pietro [Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopedics, Bologna (Italy); Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopaedics, Bologna (Italy)

    2011-06-15

    To evaluate the clinical and imaging outcome of patients with symptomatic eosinophilic granuloma of the spine treated with CT-guided intralesional methylprednisolone injection after biopsy. Patients (n =19) with symptomatic solitary eosinophilic granuloma of the spine treated by CT-guided intralesional methylprednisolone injection were retrospectively studied. There were 12 males and seven females with a mean age of 17 years (range, 3-43 years). The mean follow-up was 6 years (median, 4 years; range, 0.5-19 years). Spinal location included the cervical (two patients), thoracic (seven patients), lumbar spine (eight patients), and the sacrum (two patients). Vertebra plana was observed in two patients. All patients had biopsies before treatment. Complete resolution of pain and healing of the lesion was observed in 17 patients (89.5%); none of these patients had recurrence at the latest examination. Reconstitution of the T1 and L1 vertebra plana was observed in both patients. Two patients initially diagnosed and treated for a solitary eosinophilic granuloma had constant pain after the procedure; in these patients, 6 and 12 months after the procedure, respectively, imaging showed multifocal disease and systemic therapy was administered. Complications related to the procedure were not observed. General anesthesia was administered in two patients because of intolerable pain during the procedure. In view of the benign clinical course of eosinophilic granuloma, in patients with symptomatic lesions, CT-guided intralesional corticosteroid injection is a safe and effective outpatient treatment with a low complication rate. (orig.)

  2. CT-guided pericardiocenteses: Clinical profile, practice patterns and clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Eichler, Katrin, E-mail: k.eichler@em.uni-frankfurt.d [Department of Diagnostic and Interventional Radiology, University of Frankfurt, Frankfurt (Germany); Zangos, Stephan; Thalhammer, Axel; Jacobi, Volkmar [Department of Diagnostic and Interventional Radiology, University of Frankfurt, Frankfurt (Germany); Walcher, Felix; Marzi, Ingo [Department of Trauma, Hand and Reconstructive Surgery, University of Frankfurt, Frankfurt (Germany); Moritz, Anton [Department of Thoracic and Cardiovascular Surgery, University of Frankfurt, Frankfurt (Germany); Vogl, Thomas J.; Mack, Martin G. [Department of Diagnostic and Interventional Radiology, University of Frankfurt, Frankfurt (Germany)

    2010-07-15

    Objective: To assess the effectiveness and clinical outcome and technique of CT-guided pericardiocenteses in the treatment of pericardial effusions in adults and children. Methods: 20 drainages were performed in Seldinger-technique under CT-guidance on 20 patients suffering from pericardial effusions and haematomas. In 85%, the etiology of effusion was postoperative. The mean age of the patients was 59 years (minimum 9 years, maximum 86 years).There were 12 male and eight female patients. The inclusion criterion was an echocardiographically relevant proved pericardial effusion. Results: All catheters could be placed successfully (20/20) in the pericardial effusion and allowed for draining of the effusion in all cases under CT-guidance. The overall 30-day mortality rate was 0%. CT-guided pericardiocentesis was successful for withdrawing pericardial fluid and/or relieving tamponade in 100% of all procedures. No major complication was occurred. A total of one minor complication (5%) occurred that required no specific interventions, except for monitoring and appropriate follow-up. We observed one pneumothorax as a minor complication. Conclusions: Pericardial effusions of various causes can be safely, effectively, and quickly managed with CT-guided pericardiocenteses in adults and children. The ventrolateral entry side for the puncture should be preferred to reach the whole effusion and avoid complications, like a pneumothorax.

  3. CT-guided cervical transforaminal steroid injections: where should the needle tip be located?

    Science.gov (United States)

    Hoang, J K; Massoglia, D P; Apostol, M A; Lascola, C D; Eastwood, J D; Kranz, P G

    2013-03-01

    The aim of CT-guided CTSI is to inject medication into the foraminal region where the nerve root is inflamed. The optimal location for needle placement and therapeutic delivery, however, remain uncertain. The purpose of this study was to investigate how needle positioning and angle of approach impact the transforaminal distribution of injectate. We retrospectively reviewed fluoroscopic images from 90 CT-guided CTSI procedures for needle-tip location, needle angle, and contrast distribution. Needle-tip position was categorized as either foraminal zone, junctional, or extraforaminal. Distribution of contrast injected immediately before steroid administration was categorized as central epidural, intraforaminal, or extraforaminal in location. Needle-tip location and angle were correlated with contrast distribution. The needle tip was most commonly placed in the junctional position (36 cases, 40%), followed by foraminal (30 cases, 33%) and extraforaminal (24 cases, 27%) locations. Intraforaminal contrast distribution was highest when the needle location was foraminal (30/30, 100%) or junctional (35/36, 97%), compared with extraforaminal (7/24, 29%) (P value <.0001). There was no relationship between needle angle and contrast distribution. Needle-tip location at the outer edge of the neural foramen (junctional location) correlated well with intraforaminal distribution of contrast for CT-guided CTSI and compared favorably with injectate distribution following foraminal zone needle positioning. Junctional needle positioning may be preferred over the foraminal zone by some proceduralists. Extraforaminal needle positioning resulted in less favorable contrast distribution, which may significantly diminish the therapeutic efficacy of CTSI.

  4. Dynamic telecytologic evaluation of imprint cytology samples from CT-guided lung biopsies: A feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Prosch, Helmut [Otto Wagner Hospital, Department of Radiology, Vienna (Austria); Medical University of Vienna, Department of Radiology, Vienna (Austria); Medical University of Vienna, Vienna General Hospital, Department of Radiology, Vienna (Austria); Hoffmann, Elisabeth; Schober, Ewald; Mostbeck, Gerhard [Otto Wagner Hospital, Department of Radiology, Vienna (Austria); Bernhardt, Klaus; Schalleschak, Johann [Otto Wagner Hospital, Department of Laboratory Medicine, Vienna (Austria); Rowhani, Marcel [Otto Wagner Hospital, Department of Respiratory and Critical Care Medicine, Vienna (Austria); Weber, Michael [Medical University of Vienna, Department of Radiology, Vienna (Austria)

    2011-09-15

    This study assessed the feasibility of telecytological evaluation of samples from CT-guided lung biopsies using a dynamic telecytological system in which the microscope was operated by personnel from the radiology department at the site of the biopsy and a cytologist off-site diagnosed the biopsy sample. 45 imprint samples from CT-guided biopsies of lung lesions were reviewed by two cytologists using a telecytological microscope (Olympus BX51, Tokyo, Japan). The telecytological microscope was operated by one radiologist and one radiology technician. The cytological samples were classified by a cytologist into four categories: benign, malignant, atypical cells of undetermined significance, and non-diagnostic. The results were compared with those of a previous consensus reading of two independent cytologists (gold standard). When the radiologist was operating the microscope, the diagnostic accuracy was 100% as both cytologists came to the correct diagnosis in all samples. When the technician operated the microscope, two diagnoses of cyotologist 1 differed from the gold standard. Thus, the accuracy for the technician was 95.56%. Telecytological evaluation of imprint samples from CT-guided lung biopsies is feasible because it can be performed with high diagnostic accuracy if personnel from the radiology department operate the microscope. (orig.)

  5. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Heerink, W.J.; Vliegenthart, R. [University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, University of Groningen, Groningen (Netherlands); University Medical Center Groningen, Department of Radiology, University of Groningen, Groningen (Netherlands); Bock, G.H. de [University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, University of Groningen, Groningen (Netherlands); University Medical Center Groningen, Department of Epidemiology, University of Groningen, Groningen (Netherlands); Jonge, G.J. de [University Medical Center Groningen, Department of Radiology, University of Groningen, Groningen (Netherlands); Groen, H.J.M. [University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, University of Groningen, Groningen (Netherlands); University Medical Center Groningen, Department of Pulmonary Medicine, University of Groningen, Groningen (Netherlands); Oudkerk, M. [University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, University of Groningen, Groningen (Netherlands)

    2017-01-15

    To meta-analyze complication rate in computed tomography (CT)-guided transthoracic lung biopsy and associated risk factors. Four databases were searched from 1/2000 to 8/2015 for studies reporting complications in CT-guided lung biopsy. Overall and major complication rates were pooled and compared between core biopsy and fine needle aspiration (FNA) using the random-effects model. Risk factors for complications in core biopsy and FNA were identified in meta-regression analysis. For core biopsy, 32 articles (8,133 procedures) were included and for FNA, 17 (4,620 procedures). Pooled overall complication rates for core biopsy and FNA were 38.8 % (95 % CI: 34.3-43.5 %) and 24.0 % (95 % CI: 18.2-30.8 %), respectively. Major complication rates were 5.7 % (95 % CI: 4.4-7.4 %) and 4.4 % (95 % CI: 2.7-7.0 %), respectively. Overall complication rate was higher for core biopsy compared to FNA (p < 0.001). For FNA, larger needle diameter was a risk factor for overall complications, and increased traversed lung parenchyma and smaller lesion size were risk factors for major complications. For core biopsy, no significant risk factors were identified. In CT-guided lung biopsy, minor complications were common and occurred more often in core biopsy than FNA. Major complication rate was low. For FNA, smaller nodule diameter, larger needle diameter and increased traversed lung parenchyma were risk factors for complications. (orig.)

  6. Computed tomography-guided percutaneous biopsy of bone lesions: rate of diagnostic success and complications

    Energy Technology Data Exchange (ETDEWEB)

    Maciel, Macello Jose Sampaio; Tyng, Chiang Jeng; Barbosa, Paula Nicole Vieira Pinto; Bitencourt, Almir Galvao Vieira; Matushita Junior, Joao Paulo Kawaoka; Zurstrassen, Charles Edouard; Chung, Wu Tu; Chojniak, Rubens, E-mail: macellomaciel@me.com [A.C.Camargo Cancer Center, Sao Paulo, SP (Brazil)

    2014-09-15

    Objective: To determine the rates of diagnostic success and complications of computed tomography (CT)-guided percutaneous biopsy of bone lesions suspected for malignancy. Materials and Methods: Retrospective study including 186 cases of CT-guided percutaneous biopsies of bone lesions in the period from January, 2010 to December, 2012. All the specimens were obtained with 8-10 gauge needles. The following data were collected: demographics, previous history of malignancy, data related to the lesion, to the procedure, and to histological results. Results: Most patients were women (57%), and the mean age was 53.0 ± 16.4 years. In 139 cases (74.6%), there was diagnostic suspicion of metastasis and the most common primary tumors were breast (32.1%) and prostate (11.8%). The bones most commonly involved were spine (36.0%), hip (32.8%) and long bones (18.3%). Complications occurred in only three cases (1.6%) including bone fracture, paraesthesia with functional impairment, and needle breakage requiring surgical removal. The specimens collected from 183 lesions (98.4%) were considered appropriate for diagnosis. Malignant results were more frequently found in patients who had a suspected secondary lesion and history of known malignancy (p < 0.001), and in patients who underwent PET/CT-guided procedures (p = 0.011). Conclusion: CT-guided percutaneous biopsy is a safe and effective procedure for the diagnosis of suspicious bone lesions. (author)

  7. Survival of patients with hepatocellular carcinoma (HCC treated by percutaneous radio-frequency ablation (RFA is affected by complete radiological response.

    Directory of Open Access Journals (Sweden)

    Giuseppe Cabibbo

    Full Text Available BACKGROUND: Radio-frequency ablation (RFA has been employed in the treatment of Barcelona Clinic Liver Cancer (BCLC early stage hepatocellular carcinoma (HCC as curative treatments. AIM: To assess the effectiveness and the safety of RFA in patients with early HCC and compensated cirrhosis. METHODS: A cohort of 151 consecutive patients with early stage HCC (122 Child-Pugh class A and 29 class B patients treated with RFA were enrolled. Clinical, laboratory and radiological follow-up data were collected from the time of first RFA. A single lesion was observed in 113/151 (74.8%, two lesions in 32/151 (21.2%, and three lesions in 6/151 (4% of patients. RESULTS: The overall survival rates were 94%, 80%, 64%, 49%, and 41% at 12, 24, 36, 48 and 60 months, respectively. Complete response (CR at 1 month (p<0.0001 and serum albumin levels (p = 0.0004 were the only variables indipendently linked to survival by multivariate Cox model. By multivariate analysis, tumor size (p = 0.01 is the only variable associated with an increased likehood of CR. The proportion of major complications after treatment was 4%. CONCLUSIONS: RFA is safe and effective for managing HCC with cirrhosis, especially for patients with HCC ≤3 cm and higher baseline albumin levels. Complete response after RFA significantly increases survival.

  8. Performance of intra-procedural 18-fluorodeoxyglucose PET/CT-guided biopsies for lesions suspected of malignancy but poorly visualized with other modalities

    Energy Technology Data Exchange (ETDEWEB)

    Cornelis, F. [Memorial Sloan-Kettering Cancer Center, Department of Radiology, New York, NY (United States); Pellegrin Hospital, Department of Radiology, Bordeaux (France); Silk, M.; Takaki, H.; Durack, J.C.; Erinjeri, J.P.; Sofocleous, C.T.; Siegelbaum, R.H.; Maybody, M.; Solomon, S.B. [Memorial Sloan-Kettering Cancer Center, Department of Radiology, New York, NY (United States); Schoder, H. [Memorial Sloan-Kettering Cancer Center, Department of Nuclear Medicine, New York, NY (United States)

    2014-12-15

    We sought to evaluate the safety and the diagnostic success rate of percutaneous biopsies performed under intra-procedural {sup 18}F-deoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) guidance for lesions difficult to see with conventional cross-sectional imaging. From 2011 to 2013, consecutive clinically indicated percutaneous PET/CT-guided biopsies of 106 masses (mean size, 3.3 cm; range, 0.7-15.9 cm; SD, 2.9 cm) in bones (n = 33), liver (n = 26), soft tissues (n = 18), lung (n = 15) and abdomen (n = 14) were reviewed. The biopsy procedures were performed following injection of a mean of 255 MBq (SD, 74) FDG. Mean maximal standardized uptake value (SUV) of lesions was 8.8 (SD, 6.3). A systematic review of the histopathological results and outcomes was performed. Biopsies were positive for malignancy in 76 cases (71.7 %, 76/106) and for benign tissue in 30 cases (28.3 %, 30/106). Immediate results were considered adequate for 100 PET/CT biopsies (94.3 %, 100/106) requiring no further exploration, and for the six others (5.7 %, 6/106) benign diagnoses were confirmed after surgery (n = 4) or follow-up (n = 2). The consequent overall sensitivity and the diagnostic success of biopsy were therefore 100 %. No significant differences in terms of detection of malignancy were observed between the different locations. Lesions > 2 cm or with SUV > 4 were not significantly more likely to be malignant. Complications occurred after four biopsies (3.7 %, 4/106). Intra-procedural PET/CT guidance appears as a safe and effective method and allows high diagnostic success of percutaneous biopsies for metabolically active lesions. (orig.)

  9. 颈椎脊神经后支射频热凝术有效性的随机对照研究%PERCUTANEOUS RADIOFREQUENCY NEUROTOMY FOR CHRONIC CERVICAL ZYGAPOPHYSEAL JOINT PAIN: A RANDOMIZED CONTROLLED TRIAL

    Institute of Scientific and Technical Information of China (English)

    廖翔; 张德仁; 蒋劲; 熊东林; 张强; 肖礼祖; 郑虎山; 沙彤; 梁豪文; 罗裕辉

    2011-01-01

    目的:通过随机对照研究,评价射频热凝术治疗颈椎脊神经后支诱发慢性颈肩痛的有效性.方法:自2005年12月至2008年12月共127名患者纳入研究,所有病人均经诊断性颈椎脊神经后支阻滞有效,明确为颈椎脊神经后支诱发慢性颈肩痛.随后随机分为两组,A组采用DSA影像引导下脊神经后支射频热凝术治疗,B组采用口服药物保守治疗,随访期2年.利用视觉模拟评分法(Visual Analog Scores,VAS)进行治疗前后疗效评定.以VAS评分小于治疗前的50%视为优良疗效,反之视为疗效不佳.利用Kaplan-Meier生存曲线与Log-Rank检验进行两组疗效对比.记录手术并发症与用药副作用.结果:A组VAS评分回到术前50%的平均时间是217天,B组为27夭(P<0.0l).在第27周(治疗后200天),A组36名患者完全无痛,B组为1名.A组术后疗效优良率显著高于B组(P<0.01).B组3例病人出现胃部不适,纳差,经对症治疗后消失.A组9例病人术后出现神经支配区域的皮肤麻木,无感染及脊神经前支、椎动脉损伤等并发症.结论:对于颈椎脊神经后支诱发慢性颈肩痛,颈椎脊神经后支射频热凝术相比保守治疗,能够更有效的长期缓解疼痛,且操作安全,副作用很少.%Objective: To compare the efficacy of percutaneous radiofrequency thermocoagulation of the medial branches of the cervical dorsal rami and conservative treatment in patients with chronic neck and shoulder pain through a randomized controlled trials. Methods: From Dec. 2005 to Dec. 2008, 127 patients with chronic neck and shoulder pain were enrolled into this study and were randomly divided into two groups. All patients had a diagnosis of chronic neck and shoulder pian established by controlled medial branch blocks. Under the guidance of DSA, group A were treated with percutaneous radiofrequency thermocoagulation of the medial branches of the cervical dorsal rami via lateral approach. Group B were treated with

  10. Complications in CT-guided Procedures: Do We Really Need Postinterventional CT Control Scans?

    Energy Technology Data Exchange (ETDEWEB)

    Nattenmüller, Johanna, E-mail: johanna.nattenmueller@med.uni-heidelberg.de; Filsinger, Matthias, E-mail: Matthias_filsinger@web.de; Bryant, Mark, E-mail: mark.bryant@med.uni-heidelberg.de; Stiller, Wolfram, E-mail: Wolfram.Stiller@med.uni-heidelberg.de; Radeleff, Boris, E-mail: boris.radeleff@med.uni-heidelberg.de; Grenacher, Lars, E-mail: lars.grenacher@med.uni-heidelberg.de; Kauczor, Hans-Ullrich, E-mail: hu.kauczor@med.uni-heidelberg.de; Hosch, Waldemar, E-mail: waldemar.hosch@urz.uni-heidelberg.de [University Hospital Heidelberg, Department of Diagnostic and Interventional Radiology (Germany)

    2013-06-19

    PurposeThe aim of this study is twofold: to determine the complication rate in computed tomography (CT)-guided biopsies and drainages, and to evaluate the value of postinterventional CT control scans.MethodsRetrospective analysis of 1,067 CT-guided diagnostic biopsies (n = 476) and therapeutic drainages (n = 591) in thoracic (n = 37), abdominal (n = 866), and musculoskeletal (ms) (n = 164) locations. Severity of any complication was categorized as minor or major. To assess the need for postinterventional CT control scans, it was determined whether complications were detected clinically, on peri-procedural scans or on postinterventional scans only.ResultsThe complication rate was 2.5 % in all procedures (n = 27), 4.4 % in diagnostic punctures, and 1.0 % in drainages; 13.5 % in thoracic, 2.0 % in abdominal, and 3.0 % in musculoskeletal procedures. There was only 1 major complication (0.1 %). Pneumothorax (n = 14) was most frequent, followed by bleeding (n = 9), paresthesia (n = 2), material damage (n = 1), and bone fissure (n = 1). Postinterventional control acquisitions were performed in 65.7 % (701 of 1,067). Six complications were solely detectable in postinterventional control acquisitions (3 retroperitoneal bleeds, 3 pneumothoraces); all other complications were clinically detectable (n = 4) and/or visible in peri-interventional controls (n = 21).ConclusionComplications in CT-guided interventions are rare. Of these, thoracic interventions had the highest rate, while pneumothoraces and bleeding were most frequent. Most complications can be detected clinically or peri-interventionally. To reduce the radiation dose, postinterventional CT controls should not be performed routinely and should be restricted to complicated or retroperitoneal interventions only.

  11. CT-guided 125I Radioactive Seed Implantation on Regional Lymph Node Metastasis after Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Shi Liangrong; Wu Jun; Jiang Jingting; Wu Changping

    2013-01-01

    Objective:To evaluate the safety and short-term effect of CT-guided 125I radioactive seed implantation on regional lymph node metastasis after gastrectomy. Methods:Twenty-three patients with regional lymph node metastasis after gastrectomy received CT-guided 125I radioactive seed implantation from June, 2007 to July, 2011 in our hospital. The overall activity and amount of radioactive seeds were calculated by simulating source distribution of radioactive seed implantation plan system before operation. 125I seeds were implanted under the guidance of CT. Effective rate was evaluated according to RECIST criterion, 1, 2 and 3 years of survival rates were calculated by life table method, the effect of relative factors on survival was tested by univariate COX model, and the survival differences between subgroups were compared to draw survival curve by log-rank method. Additionally, systemic therapies were given to 20 patients based on lfuorouracil drugs. Results:No severe complications was observed in all study subjects with 14 complete remission (60.9%), 5 particle remission (21.7%) and 4 progressive diseases (17.4%), while 1, 2 and 3 years of survival rates as well as median survival time being (87±7)%,(47±11)%, (13±9)% and (22.1±5.1) months, respectively. Univariate COX analysis showed that the maximum diameter of tumor could badly inlfuence the prognosis (χ2=9.752, P=0.002), and the subgroups analysis relieved the signiifcant difference (χ2=5.828, P=0.016, log-rank test) with 3 cm being the cut-off value. Conclusion:CT-guided 125I radioactive seed implantation has high local control rate with small trauma and slight complications.

  12. CT-guided 125I Radioactive Seed Implantation on Regional Lymph Node Metastasis after Gastrectomy

    Directory of Open Access Journals (Sweden)

    Liangrong Shi

    2013-09-01

    Full Text Available Objective: To evaluate the safety and short-term effect of CT-guided 125I radioactive seed implantation on regional lymph node metastasis after gastrectomy. Methods: Twenty-three patients with regional lymph node metastasis after gastrectomy received CT-guided 125I radioactive seed implantation from June, 2007 to July, 2011 in our hospital. The overall activity and amount of radioactive seeds were calculated by simulating source distribution of radioactive seed implantation plan system before operation. 125I seeds were implanted under the guidance of CT. Effective rate was evaluated according to RECIST criterion, 1, 2 and 3 years of survival rates were calculated by life table method, the effect of relative factors on survival was tested by univariate COX model, and the survival differences between subgroups were compared to draw survival curve by log-rank method. Additionally, systemic therapies were given to 20 patients based on fluorouracil drugs. Results: No severe complications was observed in all study subjects with 14 complete remission (60.9 % , 5 particle remission (21.7 % and 4 progressive diseases (17.4 % , while 1, 2 and 3 years of survival rates as well as median survival time being (87±7 %,(47±11 % , (13±9 % and (22.1±5.1 months, respectively. Univariate COX analysis showed that the maximum diameter of tumor could badly influence the prognosis (χ2 = 9.752, P = 0.002, and the subgroups analysis relieved the significant difference (χ2 = 5.828, P = 0.016, log-rank test with 3 cm being the cut-off value. Conclusion: CT-guided 125I radioactive seed implantation has high local control rate with small trauma and slight complications.

  13. CT-Guided Radioactive {sup 125}I Seed Implantation Therapy of Symptomatic Retroperitoneal Lymph Node Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Zhongmin, E-mail: wzm0722@hotmail.com [Shanghai Jiaotong University School of Medicine, Department of Nuclear Medicine, Renji Hospital (China); Lu, Jian; Gong, Ju; Zhang, Liyun [Shanghai Jiaotong University School of Medicine, Department of Radiology, Ruijin Hospital Luwan Branch (China); Xu, Yingjia [Shanghai Jiao Tong University, Department of Cardiology, Shanghai Chest Hospital (China); Song, Shaoli [Shanghai Jiaotong University School of Medicine, Department of Nuclear Medicine, Renji Hospital (China); Chen, Kemin [Shanghai Jiaotong University School of Medicine, Department of Radiology, Ruijin Hospital (China); Liu, Fenju [Soochow University, School of Radiation Medicine and Public Health (China); Gang, Huang, E-mail: huanggang0722@hotmail.com [Shanghai Jiaotong University School of Medicine, Department of Nuclear Medicine, Renji Hospital (China)

    2013-04-12

    PurposeThis study explored the clinical efficacy of CT-guided radioactive {sup 125}I seed implantation in treating patients with symptomatic retroperitoneal lymph node metastases.MethodsTwenty-five patients with pathologically confirmed malignant tumors received CT-guided radioactive {sup 125}I seed implantation to treat metastatic lymph nodes. The diameter of the metastatic lymph nodes ranged from 1.5 to 4.5 cm. Treatment planning system (TPS) was used to reconstruct the three-dimensional image of the tumor and then calculate the corresponding quantity and distribution of {sup 125}I seeds.ResultsFollow-up period for this group of patients was 2–30 months, and median time was 16 months. Symptoms of refractory pain were significantly resolved postimplantation (P < 0.05), and Karnofsky score rose dramatically (P < 0.05). Most patients reported pain relief 2–5 days after treatment. Follow-up imaging studies were performed 2 months later, which revealed CR in 7 patients, PR in 13 patients, SD in 3 patients, and PD in 2 patients. The overall effective rate (CR + PR) was 80 %. Median survival time was 25.5 months. Seven patients died of recurrent tumor; 16 patients died of multiorgan failure or other metastases. Two patients survived after 30 months follow-up. Two patients reported localized skin erythema 1 week postimplantation, which disappeared after topical treatment.ConclusionsCT-guided radioactive {sup 125}I seed implantation, which showed good palliative pain relief with acceptable short-term effects, has proved in our study to be a new, safe, effective, and relatively uncomplicated treatment option for symptomatic retroperitoneal metastatic lymph nodes.

  14. Adrenal metastases: CT-guided and MR-thermometry-controlled laser-induced interstitial thermotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, Thomas J.; Lehnert, Thomas; Eichler, Katrin; Proschek, Dirk; Floeter, Julius; Mack, Martin G. [Johann Wolfgang Goethe University, Department of Diagnostic and Interventional Radiology, University Hospital of Frankfurt, Frankfurt am Main (Germany)

    2007-08-15

    The aim of the study was to evaluate the feasibility, safety and effectiveness of CT-guided and MR-thermometry-controlled laser-induced interstitial thermotherapy (LITT) in adrenal metastases. Nine patients (seven male, two female; average age 65.0 years; range 58.7-75.0 years) with nine unilateral adrenal metastases (mean diameter 4.3 cm) from primaries comprising colorectal carcinoma (n = 5), renal cell carcinoma (n = 1), oesophageal carcinoma (n = 1), carcinoid (n = 1), and hepatocellular carcinoma (n = 1) underwent CT-guided, MR-thermometry-controlled LITT using a 0.5 T MR unit. LITT was performed with an internally irrigated power laser application system with an Nd:YAG laser. A thermosensitive, fast low-angle shot 2D sequence was used for real-time monitoring. Follow-up studies were performed at 24 h and 3 months and, thereafter, at 6-month intervals (median 14 months). All patients tolerated the procedure well under local anaesthesia. No complications occurred. Average number of laser applicators per tumour: 1.9 (range 1-4); mean applied laser energy 33 kJ (range 15.3-94.6 kJ), mean diameter of the laser-induced coagulation necrosis 4.5 cm (range 2.5-7.5 cm). Complete ablation was achieved in seven lesions, verified by MR imaging; progression was detected in two lesions in the follow-up. The preliminary results suggest that CT-guided, MR-thermometry-controlled LITT is a safe, minimally invasive and promising procedure for treating adrenal metastases. (orig.)

  15. Do Liposomal Apoptotic Enhancers Increase Tumor Coagulation and End-Point Survival in Percutaneous Radiofrequency Ablation of Tumors in a Rat Tumor Model? 1

    Science.gov (United States)

    Yang, Wei; Elian, Mostafa; Hady, El-Shymma A.; Levchenko, Tatyana S.; Sawant, Rupa R.; Signoretti, Sabina; Collins, Michael; Torchilin, Vladimir P.; Goldberg, S. Nahum

    2010-01-01

    Purpose: To characterize effects of combining radiofrequency (RF) ablation with proapoptotic intravenous liposome-encapsulated paclitaxel and doxorubicin on tumor destruction, apoptosis and heat-shock protein (HSP) production, intratumoral drug accumulation, and end-point survival. Materials and Methods: R3230 mammary adenocarcinomas (n = 177) were implanted in 174 rats in this animal care committee–approved study. Tumors received (a) no treatment, (b) RF ablation, (c) paclitaxel, (d) RF ablation followed by paclitaxel (RF ablation–paclitaxel), (e) paclitaxel before RF ablation (paclitaxel–RF ablation), (f) RF ablation followed by doxorubicin (RF ablation–doxorubicin), (g) paclitaxel followed by doxorubicin without RF ablation (paclitaxel-doxorubicin), or (h) paclitaxel before RF ablation, followed by doxorubicin (paclitaxel–RF ablation–doxorubicin). Tumor coagulation area and diameter were compared at 24–96 hours after treatment. Intratumoral paclitaxel uptake with and without RF ablation were compared. Immunohistochemical staining revealed cleaved caspase-3 and 70-kDa HSP (HSP70) expression. Tumors were randomized into eight treatment arms for Kaplan-Meier analysis of defined survival end-point (3.0-cm diameter). Results: Paclitaxel–RF ablation increased tumor coagulation over RF ablation or paclitaxel (mean, 14.0 mm ± 0.9 [standard deviation], 6.7 mm ± 0.6, 2.5 mm ± 0.6, respectively; P RF ablation–doxorubicin had similar tumor coagulation (P RF ablation, at 24 and 96 hours. Mean intratumoral paclitaxel accumulation for paclitaxel–RF ablation (6.76 μg/g ± 0.35) and RF ablation–paclitaxel (9.28 μg/g ± 0.87) increased over that for paclitaxel (0.63 μg/g ± 0.25, P RF ablation–doxorubicin (56.8 days ± 25.3) was greater, compared with that for paclitaxel–RF ablation or RF ablation–paclitaxel (17.6 days ± 2.5), RF ablation–doxorubicin (30.3 days ± 4.9, P cellular apoptosis and HSP production effectively increases RF ablation

  16. CT-guided injection for ganglion impar blockade: a radiological approach to the management of coccydynia

    Energy Technology Data Exchange (ETDEWEB)

    Datir, A., E-mail: apdatir@gmail.co [Jackson Memorial Hospital, Miami, FL (United States); Connell, D. [Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex (United Kingdom)

    2010-01-15

    Aim: To evaluate the role of computed tomography (CT) in needle placement for ganglion impar blocks, and to determine the efficacy of CT-guided ganglion impar blocks in the management of coccydynia. Materials and methods: The results of ganglion impar blockade in eight patients with coccydynia secondary to trauma or unknown cause were reviewed. The diagnosis of coccydynia was based on clinical history, location of pain, and response to previous diagnostic and therapeutic procedures. The eight patients were treated with CT-guided ganglion impar blocks to manage their coccyx pain after conservative procedures, including oral medication and cushions, failed to provide relief. All patients were subjected to ganglion impar blocks under a thin-section CT-guided technique for needle placement, using a mixture of bupivacaine and triamcinolone. The patients were followed-up for a period of 6-months. Results: Eight patients were treated in this study with a total of 11 injections. A technical success of 100% was achieved in all cases with accurate needle placement without any complications and all the patients tolerated the procedure well. Out of eight, three patients (37%) had complete relief of pain on the follow-up intervals up to 6 months. Three out of eight patients (37%), had partial relief of symptoms and a second repeat injection was given at the 3 month interval of the follow-up period. At the end of the 6-month follow-up period, six out of eight patients (75%) experienced symptomatic relief (four complete relief and two partial relief) without any additional resort to conventional pain management. Twenty-five percent (two out of eight) did not have any symptomatic improvement. The mean visual analogue score (VAS) pre-procedure was 8 (range 6-10) and had decreased to 2 (range 0-5) in six out of eight patients. Conclusion: CT can be used as an imaging method to identify the ganglion and guide the needle in ganglion impar blockade. The advantages of CT-guided

  17. CT-guided corticosteroid injection as a therapeutic management for the pyriformis syndrome: case report.

    Science.gov (United States)

    Kabataş, Serdar; Gümüş, Burçak; Yilmaz, Cem; Caner, Hakan

    2008-07-01

    The pyriformis syndrome is a rare entrapment neuropathy in which the sciatic nerve is compromised by the pyriformis muscle or other local structures. It is an important cause of buttock pain that may often be accompanied by sciatica. The pain is usually increased by muscular contraction, palpation or prolonged sitting. The diagnosis relies on the clinical presentation and the electromyelography (EMG) findings. Other causes of symptoms should be excluded by careful examination and detailed neuroradiological studies of the lumbosacral spine, sacro-iliac and hip joints. A case of this syndrome seen in a 36-year-old man who recovered by CT-guided corticosteroid injection is reported.

  18. Therapeutical efficacy of CT-guided relief puncture in amebic liver abscesses

    Energy Technology Data Exchange (ETDEWEB)

    Mansfeld, L.; Boitz, F.; Poehls, C.; Cimanowski, N.

    1987-09-01

    Amebic liver abscesses are the most frequent clinical manifestations of the extra-intestinal amebiasis and have to be considered as a serious complication in the course of disease. The abscesses have by their risk of rupturing and bacterial superinfection quoad vitam an unfavourable prognosis. CT-guided relief punctures can, as it is demonstrated by two cases of critical amebic abscesses, effectively improve the therapy with systemic amebicides, prevent imminent rupture and contribute to the healing of the abscesses. Thus a surgical treatment of the abscess was not necessary.

  19. Effects of parecoxib on inflammatory response in patients after radio-frequency ablation for liver cancer%帕瑞昔布钠对肝癌射频消融术患者全身炎性反应的影响

    Institute of Scientific and Technical Information of China (English)

    吕帅国; 李长生; 李廷坤; 汪蕾; 孙亚林; 卢锡华

    2015-01-01

    目的 评价帕瑞昔布钠对CT引导下经皮肝癌射频消融术患者术后炎性反应的影响.方法 择期行CT引导下经皮肝癌射频消融术的患者40例,性别不限,年龄45~68岁,体质量48 ~75 kg,ASA分级Ⅱ或Ⅲ级,肝功能Child-Pugh分级A级,采用随机数字表法将患者分为对照组(C组)和帕瑞昔布钠组(P组),每组20例.麻醉诱导:静脉注射异丙酚1~2 mg/kg和芬太尼2~4 μg/kg,插入喉罩后行机械通气.麻醉维持:吸入2%七氟醚,靶控输注瑞芬太尼,血浆靶浓度4 μg/L.术中维持BIS值45 ~60.P组于手术开始时静脉注射帕瑞昔布钠40 mg,C组给予等容量氯化钠注射液.分别于麻醉前、术后2h、24h和48 h时抽取上肢静脉血样,测定血浆肿瘤坏死因子-α(TNF-α)和白细胞介素-8(IL-8)的浓度.结果 与C组比较,P组术后2h、24 h和48 h时血浆TNF-α和IL-8的浓度降低(P<0.05).结论 帕瑞昔布钠可降低CT引导下经皮肝癌射频消融患者术后全身炎性反应.%Objective To investigate the effects of parecoxib on inflammatory response in patients after CT-guided percutaneous radio-frequency ablation (RFA) for liver cancer.Methods Forty ASA Ⅱ or Ⅲ and Child-Pugh A patients of both sexes aged 45-68 years old,weighing 48-75 kg,undergoing CT-guided percutaneous radio-frequency ablation for liver cancer,were randomly divided into two groups (n =20 each):control group (group C) and parecoxib group (group P).Anesthesia was induced with propofol 1-2 mg/kg and fentanyl 2-4 pg/kg and maintained with inhalation of 2% sevoflurane and TCI remifentanil(Cp 4μg/L).Laryngeal mask airway was inserted,and the patients were mechanically ventilated.BIS value was maintained at 45-60.Blood samples were taken from veins of upper limb before surgery(T0) and at 2 h,24 h and 48 h after surgery(T1-3) for determination of plasma TNF-αand IL-8 concentrations.Results Compared with group C,plasma concentrations of TNF-α and IL-8 were significantly

  20. Computed tomography-guided percutaneous trephine removal of the nidus in osteoid osteoma patients: experience of a single center in Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Petrilli, Marcelo; Senerchia, Andreza Almeida; Petrilli, Antonio Sergio; Lederman, Henrique Manoel; Garcia Filho, Reynaldo Jesus, E-mail: andrezasenerchia@hotmail.com [Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP (Brazil). Instituto de Oncologia Pediatrica

    2015-07-15

    Objective: to report the results of computed tomography (CT)-guided percutaneous resection of the nidus in 18 cases of osteoid osteoma. Materials and methods: the medical records of 18 cases of osteoid osteoma in children, adolescents and young adults, who underwent CT-guided removal of the nidus between November, 2004 and March, 2009 were reviewed retrospectively for demographic data, lesion site, clinical outcome and complications after procedure. Results: clinical follow-up was available for all cases at a median of 29 months (range 6-60 months). No persistence of pre-procedural pain was noted on 17 patients. Only one patient experienced recurrence of symptoms 12 months after percutaneous resection, and was successfully retreated by the same technique, resulting in a secondary success rate of 18/18 (100%). Conclusion: CT-guided removal or destruction of the nidus is a safe and effective alternative to surgical resection of the osteoid osteoma nidus. (author)

  1. Percutaneous Discectomy Combined with Radiofrequency Ablation with Disc-FX for Contained Lumbar Disc Herniation: 36 Cases Report and 1-year Follow-up%Disc-FX系统治疗包容性腰椎间盘突出症疗效观察

    Institute of Scientific and Technical Information of China (English)

    隰建成; 马远征; 胡明; 崔旭; 赵文亮; 穆小静; 白一冰

    2012-01-01

    Objective To investigate short-term effect of percutaneous discectomy combined with radiofrequency ablation with Disc-FX on contained lumbar disc herniation. Methods 36 patients were reviewed and followed up with Japanese Orthopaedic Association score (JO A score), the Visual Analogue Score (VAS) and Oswestry score for 12 months. Results The scores of JO A score, VAS and Oswestry improved significantly (P<0.01) after operation. Conclusion Percutaneous discectomy combined with radiofrequency ablation with Disc-FX is effective on contained lumbar disc herniation.%目的 探讨Disc-FX系统经皮腰椎髓核摘除、射频消融术治疗包容性腰椎间盘突出症的近期疗效.方法 对36例患者进行回顾性分析.结果 36例患者术后JOA评分系统评分、视觉模拟评分(VAS)及疼痛功能指数评分(Oswestry2.0)较术前明显改善(P<0.01).结论 Disc-FX系统是治疗包容性腰椎间盘突出症的有效方法.

  2. Computer navigation-guided percutaneous radiofrequency ablation of the osteoid osteomas:13-case report%计算机导航辅助经皮射频消融治疗骨样骨瘤13例报告

    Institute of Scientific and Technical Information of China (English)

    鱼锋; 张清; 赵海涛; 徐立辉; 牛晓辉

    2014-01-01

    目的:探讨计算机导航技术辅助经皮射频消融治疗骨样骨瘤手术方法和临床效果。方法回顾性分析2011年6月至2012年11月,我科应用计算机导航辅助经皮射频消融治疗骨样骨瘤13例的临床资料,其中男12例,女1例,平均16.5(8~36)岁。术前均经局部X线、CT、MRI明确诊断。肿瘤位于股骨干4例、股骨粗隆2例、股骨颈2例、股骨髁2例、胫骨干2例、跟骨1例。13例均采用Iso-C 3D C型臂术中实时导航,计算机软件均使用Stryker公司的脊柱导航软件。术中导航指引定位,骨活检针(9G )精确到达瘤巢,行穿刺活检,保留套筒,将射频针导入瘤巢,90℃消融6 min。术后进行随访,并采用疼痛视觉类比评分法( VAS )和术后X线、CT判断疗效。结果13例均获11.2(4~20)个月的随访。全部病例均完成计算机导航辅助下射频消融手术,11例组织病理学确诊为骨样骨瘤,2例组织学无法诊断,病理确诊率85%。术后疼痛即刻缓解,VAS评分显著降低。术前平均4.7,术后3天1.3,术后3个月为0.1,差异有统计学意义( P<0.05)。全部病例随访未见肿瘤复发和疼痛复发。结论经皮射频消融治疗骨样骨瘤是一种简单、安全、有效的治疗方法。计算机导航技术的应用,使术中瘤巢定位更精确,使手术治疗的微创化成为现实。%Objective To investigate the surgical method and clinical results of computer navigation-guided percutaneous radiofrequency ablation ( RFA ) in the treatment of osteoid osteomas. Methods From June 2011 to November 2012, 13 patients with osteoid osteomas were treated with computer navigation-guided percutaneous RFA, whose clinical data were retrospectively analyzed. There were 12 men and 1 woman with a mean age of 16.5 years old ( range;8-36 years ). Preoperatively all the diagnoses were conifrmed by the local X-ray, CT and MRI examinations. The femoral diaphysis was the most

  3. Trans-sphenoidal treatment of postsurgical cerebrospinal fluid fistula: CT-guided closure

    Energy Technology Data Exchange (ETDEWEB)

    Floris, R. [Rome-2 Univ., Rome (Italy). Dept. of Radiology]|[IRCCS Santa Lucia, Rome (Italy)]|[Via A. Caroncini 27, I-00197 Rome (Italy); Salvatore, C.; Simonetti, G. [Rome-2 Univ., Rome (Italy). Dept. of Radiology; Fraioli, B.; Pastore, F.S.; Vagnozzi, R. [Department of Neurosurgery, University of Rome ``Tor Vergata``, Rome (Italy)

    1998-10-01

    Cerebrospinal fluid (CSF) leakage after trans-sphenoidal surgery is a troublesome complication with a risk of meningitis and pneumocephalus. We suggest CT-guided intrasphenoidal injection of fibrin sealant through a 12-gauge needle as a simple alternative to surgical management of CSF fistulae. We treated eight patients, operated via the trans-sphenoidal route (five pituitary adenomas, three craniopharyngiomas), for a postoperative CSF leak by CT-guided intrasphenoidal injection of fibrin sealant alone in three cases and fibrin sealant and autologous blood in 5. CT was obtained 10 days after the procedure in all cases. In four patients, the CSF leak was closed successfully at the first attempt. The procedure was repeated on the four remaining patients because only a reduction in leakage was obtained at the first attempt. This procedure preserves olfaction and avoids the risk of frontal lobe damage. It could therefore represent the treatment of choice in many cases of anterior cranial fossa postsurgical CSF leaks. (orig.) (orig.) With 3 figs., 1 tab., 30 refs.

  4. The kinematics modeling based on Spinor theory for CT-guided hybrid robot

    Institute of Scientific and Technical Information of China (English)

    Tang Can; Liu Da; Wang Tianmiao; Yun Chao

    2009-01-01

    This paper focused on a simplified method for solving the hybrid robot kinematics in CT-guided (computerized tomography, CT) surgery. By position constraint introduced, the hybrid robot can be transformed as a redundant serial 7-DOF robot. The forward displacement calculation was developed based on the product-of-exponential formula (POE). Because of the kinematics complexity of the hybrid and redundant robot, the combination technique of Ulrich two-step iteration method and paul variables detachment method (UTI-PVD) was introduced to fulfill the inverse kinematics of redundant robot, the novelty of which lay in the flexibility of various robots structures and in high calculation efficiency for real-time control. The process of solving the inverse displacement was analyzed. The UTI-PVD method can be applicable to kinematics of many robots, especially for redundant robots with more than 6DOF. The kinematics simulation was provided, and robot dexterity analysis was presented. The results indicated that the hybrid robot could implement the minimally invasive CT-guided surgery.

  5. Using a Motion Sensor-Equipped Smartphone to Facilitate CT-Guided Puncture.

    Science.gov (United States)

    Hirata, Masaaki; Watanabe, Ryouhei; Koyano, Yasuhiro; Sugata, Shigenori; Takeda, Yukie; Nakamura, Seiji; Akamune, Akihisa; Tsuda, Takaharu; Mochizuki, Teruhito

    2017-04-01

    To demonstrate the use of "Smart Puncture," a smartphone application to assist conventional CT-guided puncture without CT fluoroscopy, and to describe the advantages of this application. A puncture guideline is displayed by entering the angle into the application. Regardless of the angle at which the device is being held, the motion sensor ensures that the guideline is displayed at the appropriate angle with respect to gravity. The angle of the smartphone's liquid crystal display (LCD) is also detected, preventing needle deflection from the CT slice image. Physicians can perform the puncture procedure by advancing the needle using the guideline while the smartphone is placed adjacent to the patient. In an experimental puncture test using a sponge as a target, the target was punctured at 30°, 50°, and 70° when the device was tilted to 0°, 15°, 30°, and 45°, respectively. The punctured target was then imaged with a CT scan, and the puncture error was measured. The mean puncture error in the plane parallel to the LCD was less than 2°, irrespective of device tilt. The mean puncture error in the sagittal plane was less than 3° with no device tilt. However, the mean puncture error tended to increase when the tilt was increased. This application can transform a smartphone into a valuable tool that is capable of objectively and accurately assisting CT-guided puncture procedures.

  6. CT-guided aspiration lung biopsy for EGFR and ALK gene mutation analysis of lung cancer

    Science.gov (United States)

    Lian, Weisheng; Ouyang, Yong

    2017-01-01

    The present study investigated the rates of detection and the positive rates of computed tomography (CT)-guided aspiration of lung biopsy for epidermal growth factor receptor (EGFR) gene and anaplastic lymphoma kinase (ALK) gene, and analyzed the relationship between gene mutation and clinical characteristics to improve the rate of related factors of gene detection. The clinical data and CT-guided aspiration biopsy specimen of 250 patients with lung cancer. Data showed that the rate of EGFR gene mutation was 41.2% (103/250) in biopsy specimens of non-small cell lung cancer patients. The rate of EGFR gene mutation of adenocarcinoma (56.6%, P50 was higher. The rate of ALK protein immunohistochemical detection was 87.2%, and the rate of coarse needle biopsy detection was higher than that of the fine needle (91 and 72%, Pneedle biopsy and fine needle biopsy had no difference (P>0.05). The rate of detection was associated with tumor cell number (P0.05). The rate of detection of EGFR and ALK genes was associated with tumor cell number and had no correlation with the proportion of tumor cells. The rate of detection is higher when the number of tumor cells is more than 50. PMID:28521447

  7. Pain Outcomes in Patients Undergoing CT-Guided Celiac Plexus Neurolysis for Intractable Abdominal Visceral Pain.

    Science.gov (United States)

    Edelstein, Mark R; Gabriel, Ryan T; Elbich, Jeffrey D; Wolfe, Luke G; Sydnor, Malcolm K

    2017-03-01

    The purpose of this study was to assess outcomes in patients who have undergone celiac plexus neurolysis (CPN) as treatment for refractory abdominal visceral pain at a tertiary care medical center. This study involved retrospective analysis of all patients who had undergone computed tomography (CT)-guided CPN over a 7-year period, as identified in the medical record. Cases were categorized into 1 of 3 groups-group 1: patients getting at least moderate improvement in pain but with improvements subsiding within 2 days; group 2: patients with some sustained pain relief but still requiring heavy doses of narcotics; group 3: patients with major or complete sustained reduction in pain where the narcotic dose was able to be reduced. One hundred thirty-eight cases were identified, 51 of which had no or insufficient follow-up, leaving 87 cases for analysis. Of the 87 cases, 31 (36%) were categorized as group 1, 21 (24%) as group 2, and 35 (40%) as group 3. There were no statistical differences in outcomes based on patient age, gender, time since diagnosis, or type of cancer. Documented postoperative complications were diarrhea (11 cases) and 1 case each of obtundation, hypotension, and presyncopal event. We conclude that patients undergoing CT-guided CPN for abdominal visceral pain achieve moderate or major short-term pain relief in a majority of cases. The procedure is safe with minimal complications.

  8. CT-guided high-dose-rate brachytherapy in the interdisciplinary treatment of patients with liver metastases of pancreatic cancer.

    Science.gov (United States)

    Wieners, Gero; Schippers, Alexander Christian; Collettini, Federico; Schnapauff, Dirk; Hamm, Bernd; Wust, Peter; Riess, Hanno; Gebauer, Bernhard

    2015-10-01

    CT-guided high-dose-rate brachytherapy (CT-HDRBT) is an interventional radiologic technique for local ablation of primary and secondary malignomas applying a radiation source through a brachycatheter percutaneously into the targeted lesion. The aim of this study was to assess local tumor control, safety and efficacy of CT-HDRBT in the treatment of liver metastases of pancreatic cancer. Twenty consecutive patients with 49 unresectable liver metastases of pancreatic cancer were included in this retrospective trial and treated with CT-HDRBT, applied as a single fraction high-dose irradiation (15-20 Gy) using a 192Ir-source. Primary endpoint was local tumor control and secondary endpoints were complications, progression-free survival and overall survival. The mean tumor diameter was 29 mm (range 10-73). The mean irradiation time was 20 minutes (range 7-42). The mean coverage of the clinical target volume was 98% (range 88%-100%). The mean D100 was 18.1 Gy and the median D100 was 19.78 Gy. Three major complications occurred with post-interventional abscesses, three of which were seen in 15 patients with biliodigestive anastomosis (20%) and overall 15%. The mean follow-up time was 13.7 months (range 1.4-55.0). The median progression-free survival was 4.9 months (range 1.4-42.9, mean 9.4). Local recurrence occurred in 5 (10%) of 49 metastases treated. The median overall survival after CT-HDRBT was 8.6 months (range 1.5-55.3). Eleven patients received chemotherapy after ablation with a median progression-free survival of 4.9 months (mean 12.9). Nine patients did not receive chemotherapy after intervention with a median progression-free survival of 3.2 months (mean 5.0). The rate of local tumor control was 91% in both groups after 12 months. CT-HDRBT was safe and effective for the treatment of liver metastases of pancreatic cancer.

  9. Application of color Dopplar ultrasound-guided percutaneous radiofrequency ablation in treatment of thyroid neoplasms%彩超引导在经皮穿刺射频消融治疗甲状腺肿瘤中的价值

    Institute of Scientific and Technical Information of China (English)

    孔爱红; 杨世财; 刘佳

    2011-01-01

    目的:评价彩超引导在经皮穿刺射频消融治疗甲状腺肿瘤中的应用价值.方法:对确诊为甲状腺腺瘤及囊腺瘤的患者30例,均采用彩超引导下进行穿刺途径的麻醉,并同时在甲状腺与颈动脉鞘之间、甲状腺与食管气管之间注射麻药,然后彩超导向将射频针刺入肿瘤的中心位置进行消融并通过超声实时观察,当肿瘤完全被强回声覆盖.确定完成治疗.结果:本组30例均成功射频消融,单次单点成功消融9例,两点消融13例,三点消融8例,最短需用3 min,最长需用10 min,平均(4.5±1.3)min,术中未出现损伤周围组织、大出血等并发症.结论:射频消融治疗甲状腺肿瘤是一种新兴的微创治疗方法,而彩色超声的实时引导并监控治疗,是手术成功的关键.%Objective: To evaluate the application value of color Dopplar ultrasound-guided percutaneous radiofrequency ablation (RFA) in treatment of thyroid neoplasms.Methods: 30 patients who were diagnosed with thyroid adenoma and sac adenoma accepted ultrasound-guided anesthesia.Anesthetic were injected between carotid scabbard and thyroid; between gullet, trachea and thyroid at the same time.Under real-time color ultrasonic guided and monitoring, RFA needles were pierced to the center location of tumor to do ablation therapy, when the tumor was completely covered with strong echo, the treatment completed.Results: The 30 cases all were successful, among them, 9 cases used single-point ablation treatment, 13 cases used two-point ablation treatment and 8 cases used three-point ablation treatment.The shortest time was 3min-utes, the longest time was 10 minutes, with an average of (4.5±1.3) minutes.In the operation, all the cases did not have the surrounding tissue damage, the massive hemorrhage or ether complications.Conclusion: Radiofrequency ablation for thyroid neoplasms is a new type of minimally invasive treatment method, and the real-time color ultrasonic guided and

  10. Feasibility of radiofrequency ablation as an alternative to surgical intervention in patients with huge multiloculated pyogenic liver abscesses: A retrospective cohort study.

    Science.gov (United States)

    Ke, Shan; Ding, Xue-Mei; Gao, Jun; Wang, Shao-Hong; Kong, Jian; Xu, Li; Sun, Wen-Bing

    2016-12-01

    This retrospective cohort study investigated the feasibility of radiofrequency (RF) ablation as an alternative to surgical intervention in patients with huge multiloculated pyogenic liver abscesses (PLAs).From August 2010 to April 2016, 83 patients with PLA were admitted to Beijing Chao-Yang Hospital, China. Four of these patients had huge multiloculated PLAs and underwent RF ablation plus antibiotics. The inclusion criteria for RF ablation were as follows: multiloculated PLA confirmed by computed tomography (CT) or magnetic resonance imaging (MRI), widest diameter of the PLA ≥5 cm, failure to respond to or not suitable to treatment with percutaneous drainage (PD), and patient refusal of surgery. The safety and effectiveness of RF ablation were initially assessed. All patients were commenced on antibiotics on admission to our hospital. CT-guided percutaneous catheter drainage was attempted in one patient but was unsuccessful. The main organism isolated from cultures of these patients' blood or abscess samples was Klebsiella pneumoniae (3/4). RF ablation was performed as soon as eligibility according to the above criteria was established.RF ablation was technically successful in all 4 study patients, all PLAs being completely eradicated. The median duration of fever after RF ablation was 4.5 days. No abscesses recurred; thus, this strategy for managing PLA was 100% successful (4/4). No procedure-related deaths or major complications occurred. One patient had an asymptomatic right pleural effusion that resolved with conservative treatment including albumin infusion and diuretics.Our preliminary data indicate that RF ablation is a safe, feasible, and effective treatment for huge multiloculated PLAs. It should be considered as an alternative treatment for patients who fail to respond to or not suitable for PD plus antibiotics and refuse surgical intervention.

  11. Percutaneous laser photocoagulation of osteoid osteomas under CT guidance

    Energy Technology Data Exchange (ETDEWEB)

    Friend, D.E. de; Smith, S.P.; Hughes, P.M

    2003-03-01

    AIM: The aim was to evaluate laser photocoagulation and the use of the Bonopty needle system in the treatment of osteoid osteoma. MATERIALS AND METHODS: Five patients with osteoid osteomas were treated with computed tomography (CT)-guided, percutaneous laser photocoagulation using the Bonopty biopsy system. RESULTS: Complete pain relief was obtained in four patients. In one patient, pain persisted until the 6 weeks follow-up but resolved within 24 h of repeating the procedure. There were no complications, and patients remained symptom free at follow-up of 4-23 months (mean, 14 months). CONCLUSION: CT-guided laser photocoagulation of osteoid osteoma is a minimally invasive technique that represents a cost-effective alternative to surgical excision. The Bonopty needle system allows successful penetration of the sclerotic bone surrounding the nidus with manual pressure alone.

  12. CT-guided fine needle aspiration cytology diagnosis of extra-adrenal pheochromocytoma

    Directory of Open Access Journals (Sweden)

    Rangaswamy M

    2010-01-01

    Full Text Available Pheochromocytoma is a rare tumor, accounting for <0.1% of the hypertensive population. Extra-adrenal pheochromocytomas (EAPs are rarer still, accounting for 10% of all pheochromocytomas. Pheochromocytomas are functional catecholamine-secreting tumors of the paraganglionic chromaffin cells found in the adrenal medulla and the extra-adrenal paraganglia cells. EAPs are readily detected by computed tomography (CT as soft tissue masses closely associated with the entire length of the abdominal aorta. Here, we present a rare case of EAP in a 45-year-old male hypertensive patient diagnosed by CT-guided fine needle aspiration cytology. The smears showed loosely cohesive tumor cells with prominent anisokaryosis and abundant eosinophilic, granular cytoplasm. The diagnosis was later confirmed by histopathology. The present case also highlights the fact that fine needle aspiration of pheochromocytoma is not necessarily contraindicated.

  13. CT-guided fine needle aspiration cytology diagnosis of extra-adrenal pheochromocytoma.

    Science.gov (United States)

    Rangaswamy, M; Kumar, Sandeep P; Asha, M; Manjunath, Gv

    2010-01-01

    Pheochromocytoma is a rare tumor, accounting for accounting for 10% of all pheochromocytomas. Pheochromocytomas are functional catecholamine-secreting tumors of the paraganglionic chromaffin cells found in the adrenal medulla and the extra-adrenal paraganglia cells. EAPs are readily detected by computed tomography (CT) as soft tissue masses closely associated with the entire length of the abdominal aorta. Here, we present a rare case of EAP in a 45-year-old male hypertensive patient diagnosed by CT-guided fine needle aspiration cytology. The smears showed loosely cohesive tumor cells with prominent anisokaryosis and abundant eosinophilic, granular cytoplasm. The diagnosis was later confirmed by histopathology. The present case also highlights the fact that fine needle aspiration of pheochromocytoma is not necessarily contraindicated.

  14. Cerebellar and brainstem infarction as a complication of CT-guided transforaminal cervical nerve root block

    Energy Technology Data Exchange (ETDEWEB)

    Suresh, S. [The Royal National Orthopaedic Hospital NHS Trust, London (United Kingdom); Berman, J. [The Royal National Orthopaedic Hospital NHS Trust, Anaesthetic Department, London (United Kingdom); Connell, David A. [The Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, London (United Kingdom)

    2007-05-15

    A 60-year-old man with a 4-year history of intractable neck pain and radicular pain in the C5 nerve root distribution presented to our department for a CT-guided transforaminal left C5 nerve root block. He had had a similar procedure on the right 2 months previously, and had significant improvement of his symptoms with considerable pain relief. On this occasion he was again accepted for the procedure after the risks and potential complications had been explained. Under CT guidance, a 25G spinal needle was introduced and after confirmation of the position of the needle, steroid was injected. Immediately the patient became unresponsive, and later developed a MR-proven infarct affecting the left vertebral artery (VA) territory. This is the first report of a major complication of a cervical root injection under CT guidance reported in the literature. We present this case report and the literature review of the potential complications of this procedure. (orig.)

  15. CT-guided brachytherapy of prostate cancer: reduction of effective dose from X-ray examination

    Science.gov (United States)

    Sanin, Dmitriy B.; Biryukov, Vitaliy A.; Rusetskiy, Sergey S.; Sviridov, Pavel V.; Volodina, Tatiana V.

    2014-03-01

    Computed tomography (CT) is one of the most effective and informative diagnostic method. Though the number of CT scans among all radiographic procedures in the USA and European countries is 11% and 4% respectively, CT makes the highest contribution to the collective effective dose from all radiographic procedures, it is 67% in the USA and 40% in European countries [1-5]. Therefore it is necessary to understand the significance of dose value from CT imaging to a patient . Though CT dose from multiple scans and potential risk is of great concern in pediatric patients, this applies to adults as well. In this connection it is very important to develop optimal approaches to dose reduction and optimization of CT examination. International Commission on Radiological Protection (ICRP) in its publications recommends radiologists to be aware that often CT image quality is higher than it is necessary for diagnostic confidence[6], and there is a potential to reduce the dose which patient gets from CT examination [7]. In recent years many procedures, such as minimally invasive surgery, biopsy, brachytherapy and different types of ablation are carried out under guidance of computed tomography [6;7], and during a procedures multiple CT scans focusing on a specific anatomic region are performed. At the Clinics of MRRC different types of treatment for patients with prostate cancer are used, incuding conformal CT-guided brachytherapy, implantation of microsources of I into the gland under guidance of spiral CT [8]. So, the purpose of the study is to choose optimal method to reduce radiation dose from CT during CT-guided prostate brachytherapy and to obtain the image of desired quality.

  16. CT-guided celiac plexus block with absolute alcohol : the anterior approach

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Min; Lee, Mi Suk; Jang, Young Ik; Kim, Jeong Hoi; Ym, Seong Hee; Lee, Jin Hee [Namwon Medical Center, Namwon (Korea, Republic of); Han, Young Min; Kim, Chong Soo; Choi, Ki Chul [Chonbuk National Univ. College of Medicine, Chonju (Korea, Republic of)

    1997-07-01

    To evaluate the safety and efficacy of CT-guided celiac plexus block (CPB) using an anterior approach, and to determine the role of CT in this procedure. CPB was attempted in 15 patients(10 men and 5 women;mean age, 62.3 years) with intractable upper abdominal pain due to terminal malignancy of the pancreas, liver, bowel,and kidney. To permit an anterior approach, patients lied supine on the CT scan table during the procedure. One or two 21-guage needles were placed just anterior to the diaphragmatic crus at or between the levels of the celiac and superior mesenteric arteries and 10-40ml of 99.9% alcohol was injected. Pain relief following the procedure was assessed and pain was graded on a visual analogue scale (VAS) from 0 to 10. There were no technical failures and no neurologic or hemorrhagic complications. Abdominal pain during alcohol injection occurred in all patients, and transient hypotension in three. One patient with recurrent cancer of the pancreatic head died of sepsis five days after the procedure;the cause of sepsis was difficult to determine, but there was thought to be a biliary source of infection. Two days after block, 13 of 15 procedures(86.7%) had produced at least partial pain relief;in 12 patients, relief was good. With CT guidance, more directed positioning of the needle is possible, allowing alcohol to be deposited in specific ganglion areas. CT-guided celiac plexus block using an anterior approach was an easy and effective way of reducing intractable upper abdominal pain due to terminal malignancies. CT guidance allowed precise needle placement and a safer procedure.

  17. Value of CT-guided core-needle biopsy in diagnosis and classification of malignant lymphomas using automated biopsy gun

    Institute of Scientific and Technical Information of China (English)

    Li Li; Qiu-Liang Wu; Li-Zhi Liu; Yun-Xian Mo; Chuan-Miao Xie; Lie Zheng; Lin Chen; Pei-Hong Wu

    2005-01-01

    AIM: To evaluate the value of CT-guided core-needle biopsy in diagnosis and classification of malignant lymphomas.METHODS: From January 1999 to October 2004, CT-guided core-needle biopsies were performed in 80 patients with suspected malignant lymphoma. Biopsies were performed with an 18-20 G biopsy-cut (CR Bard, Inc., Covington, GA,USA) needle driven by a spring-loaded Bard biopsy gun.RESULTS: A definite diagnosis and accurate histological subtype were obtained in 61 patients with a success rate of 76.25% (61/80). Surgical sampling was performed in 19 patients (23.75%) with non-diagnostic core-needle biopsies. The success rate of CT-guided core-needle biopsy varied with the histopathologic subtypes in our group.The relatively high success rates of core-needle biopsy were noted in diffuse large B-cell non-Hodgkin's lymphoma (NHL, 88.89%) and peripheral T-cell NHL (90%). However,the success rates were relatively low in anaplastic large cell (T/null cell) lymphoma (ALCL, 44.44%) and Hodgkin's disease (HD, 28.57%) in our group.CONCLUSION: CT-guided core-needle biopsy is a reliable means of diagnosing and classifying malignant lymphomas,and can be widely applied in the management of patients with suspected malignant lymphoma.

  18. Transarterial embolization (TAE) as add-on to percutaneous radiofrequency ablation (RFA) for the treatment of renal tumors: Review of the literature, overview of state-of-the-art embolization materials and further perspective of advanced image-guided tumor ablation.

    Science.gov (United States)

    Sommer, C M; Pallwein-Prettner, L; Vollherbst, D F; Seidel, R; Rieder, C; Radeleff, B A; Kauczor, H U; Wacker, F; Richter, G M; Bücker, A; Rodt, T; Massmann, A; Pereira, P L

    2017-01-01

    Percutaneous radiofrequency ablation (RFA) for the treatment of stage I renal cell carcinoma has recently gained significant attention as the now available long-term and controlled data demonstrate that RFA can result in disease-free and cancer-specific survival comparable with partial and/or radical nephrectomy. In the non-controlled single center trials, however, the rates of treatment failure vary. Operator experience and ablation technique may explain some of the different outcomes. In the controlled trials, a major limitation is the lack of adequate randomization. In case reports, original series and overview articles, transarterial embolization (TAE) before percutaneous RFA was promising to increase tumor control and to reduce complications. The purpose of this study was to systematically review the literature on TAE as add-on to percutaneous RFA for renal tumors. Specific data regarding technique, tumor and patient characteristics as well as technical, clinical and oncologic outcomes have been analyzed. Additionally, an overview of state-of-the-art embolization materials and the radiological perspective of advanced image-guided tumor ablation (TA) will be discussed. In conclusion, TAE as add-on to percutaneous RFA is feasible and very effective and safe for the treatment of T1a tumors in difficult locations and T1b tumors. Advanced radiological techniques and technologies such as microwave ablation, innovative embolization materials and software-based solutions are now available, or will be available in the near future, to reduce the limitations of bland RFA. Clinical implementation is extremely important for performing image-guided TA as a highly standardized effective procedure even in the most challenging cases of localized renal tumors. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. Risk factor analysis of pulmonary hemorrhage complicating CT-guided lung biopsy in coaxial and non-coaxial core biopsy techniques in 650 patients

    Energy Technology Data Exchange (ETDEWEB)

    Nour-Eldin, Nour-Eldin A., E-mail: nour410@hotmail.com [Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe – University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany); Diagnostic and Interventional Radiology Department, Cairo University Hospital, Cairo (Egypt); Alsubhi, Mohammed [Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe – University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany); Naguib, Nagy N. [Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe – University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany); Diagnostic and Interventional Radiology Department, Alexandria University Hospital, Alexandria (Egypt); Lehnert, Thomas; Emam, Ahmed; Beeres, Martin; Bodelle, Boris; Koitka, Karen; Vogl, Thomas J.; Jacobi, Volkmar [Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe – University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany)

    2014-10-15

    Purpose: To evaluate the risk factors involved in the development of pulmonary hemorrhage complicating CT-guided biopsy of pulmonary lesions in coaxial and non-coaxial techniques. Materials and methods: Retrospective study included CT-guided percutaneous lung biopsies in 650 consecutive patients (407 males, 243 females; mean age 54.6 years, SD: 5.2) from November 2008 to June 2013. Patients were classified according to lung biopsy technique in coaxial group (318 lesions) and non-coaxial group (332 lesions). Exclusion criteria for biopsy were: lesions <5 mm in diameter, uncorrectable coagulopathy, positive-pressure ventilation, severe respiratory compromise, pulmonary arterial hypertension or refusal of the procedure. Risk factors for pulmonary hemorrhage complicating lung biopsy were classified into: (a) patient's related risk factors, (b) lesion's related risk factors and (d) technical risk factors. Radiological assessments were performed by two radiologists in consensus. Mann–Whitney U test and Fisher's exact tests for statistical analysis. p values <0.05 were considered statistically significant. Results: Incidence of pulmonary hemorrhage was 19.6% (65/332) in non-coaxial group and 22.3% (71/318) in coaxial group. The difference in incidence between both groups was statistically insignificant (p = 0.27). Hemoptysis developed in 5.4% (18/332) and in 6.3% (20/318) in the non-coaxial and coaxial groups respectively. Traversing pulmonary vessels in the needle biopsy track was a significant risk factor of the development pulmonary hemorrhage (incidence: 55.4% (36/65, p = 0.0003) in the non-coaxial group and 57.7% (41/71, p = 0.0013) in coaxial group). Other significant risk factors included: lesions of less than 2 cm (p value of 0.01 and 0.02 in non-coaxial and coaxial groups respectively), basal and middle zonal lesions in comparison to upper zonal lung lesions (p = 0.002 and 0.03 in non-coaxial and coaxial groups respectively), increased lesion

  20. Image-guided radiofrequency ablation of hepatocellular carcinoma (HCC): Is MR guidance more effective than CT guidance?

    Energy Technology Data Exchange (ETDEWEB)

    Clasen, Stephan, E-mail: stephan.clasen@med.uni-tuebingen.de [University Hospital, Department of Diagnostic and Interventional Radiology, Hoppe-Seyler Str. 3, 72076 Tübingen (Germany); Rempp, Hansjörg, E-mail: hansjoerg.rempp@med.uni-tuebingen.de [University Hospital, Department of Diagnostic and Interventional Radiology, Hoppe-Seyler Str. 3, 72076 Tübingen (Germany); Hoffmann, Rüdiger, E-mail: ruediger.hoffmann@med.uni-tuebingen.de [University Hospital, Department of Diagnostic and Interventional Radiology, Hoppe-Seyler Str. 3, 72076 Tübingen (Germany); Graf, Hansjörg, E-mail: hansjoerg.graf@med.uni-tuebingen.de [University Hospital, Department of Diagnostic and Interventional Radiology, Section of Experimental Radiology, Hoppe-Seyler Str. 3, 72076 Tübingen (Germany); Pereira, Philippe L., E-mail: Philippe.Pereira@slk-kliniken.de [SLK Clinic Heilbronn, Clinic for Radiology, Minimal-invasive Therapies, and Nuclear Medicine, Am Gesundbrunnen 20-26, 74078 Heilbronn (Germany); Claussen, Claus D., E-mail: claus.claussen@med.uni-tuebingen.de [University Hospital, Department of Diagnostic and Interventional Radiology, Hoppe-Seyler Str. 3, 72076 Tübingen (Germany)

    2014-01-15

    Objectives: The purpose of the study was to retrospectively compare technique effectiveness of computed tomography (CT)-guided versus magnetic resonance (MR)-guided radiofrequency (RF) ablation of hepatocellular carcinoma (HCC). Materials and methods: In 35 consecutive patients 53 CT-guided (n = 29) or MR-guided (n = 24) ablation procedures were performed in the treatment of 56 (CT: 29; MR: 27) HCC. The entire ablation procedure was performed at a multislice CT-scanner or an interventional 0.2-Tesla MR-scanner. Assessment of treatment response was based on dynamic MR imaging at 1.5 Tesla. The mean follow-up was 22.9 months. Primary technique effectiveness was assessed 4 months after ablation therapy. Secondary technique effectiveness was assessed 4 months after a facultative second ablation procedure. Primary and secondary technique effectiveness of CT-guided and MR-guided RF ablation was compared by using Chi-Square (likelihood ratio) test. Results: Primary technique effectiveness after a single session was achieved in 26/27 (96.3%) HCC after MR-guided RF ablation and 23/29 (79.3%) HCC after CT-guided RF ablation (Chi-Square: p = 0.04). Secondary technique effectiveness was achieved in 26/27 (96.3%) HCC after MR-guided RF ablation and in 26/29 (89.7%) HCC after CT-guided RF ablation (Chi-Square: p = 0.32). A local tumor progression was detected in 8/52 (15.4%) tumors after initial technique effectiveness. Major complications were detected after 3/53 (5.7%) ablation procedures. Conclusions: CT-guided and MR-guided RF ablations are locally effective therapies in the treatment of HCC. Due to a higher rate of primary technique effectiveness MR-guided RF ablation may reduce the number of required sessions for complete tumor treatment.

  1. Comparison of cone-beam CT-guided and CT fluoroscopy-guided transthoracic needle biopsy of lung nodules

    Energy Technology Data Exchange (ETDEWEB)

    Rotolo, Nicola; Imperatori, Andrea; Arlant, Veronica; Dominioni, Lorenzo [Insubria University, Center for Thoracic Surgery, Varese (Italy); Floridi, Chiara; Fontana, Federico; Ierardi, Anna Maria; Mangini, Monica; De Marchi, Giuseppe; Fugazzola, Carlo; Carrafiello, Gianpaolo [Insubria University, Radiology Department, Varese (Italy); Novario, Raffaele [Insubria University, Medical Physics Department, Varese (Italy)

    2016-02-15

    To compare the diagnostic performance of cone-beam CT (CBCT)-guided and CT fluoroscopy (fluoro-CT)-guided technique for transthoracic needle biopsy (TNB) of lung nodules. The hospital records of 319 consecutive patients undergoing 324 TNBs of lung nodules in a single radiology unit in 2009-2013 were retrospectively evaluated. The newly introduced CBCT technology was used to biopsy 123 nodules; 201 nodules were biopsied by conventional fluoro-CT-guided technique. We assessed the performance of the two biopsy systems for diagnosis of malignancy and the radiation exposure. Nodules biopsied by CBCT-guided and by fluoro-CT-guided technique had similar characteristics: size, 20 ± 6.5 mm (mean ± standard deviation) vs. 20 ± 6.8 mm (p = 0.845); depth from pleura, 15 ± 15 mm vs. 15 ± 16 mm (p = 0.595); malignant, 60 % vs. 66 % (p = 0.378). After a learning period, the newly introduced CBCT-guided biopsy system and the conventional fluoro-CT-guided system showed similar sensitivity (95 % and 92 %), specificity (100 % and 100 %), accuracy for diagnosis of malignancy (96 % and 94 %), and delivered non-significantly different median effective doses [11.1 mSv (95 % CI 8.9-16.0) vs. 14.5 mSv (95 % CI 9.5-18.1); p = 0.330]. The CBCT-guided and fluoro-CT-guided systems for lung nodule biopsy are similar in terms of diagnostic performance and effective dose, and may be alternatively used to optimize the available technological resources. (orig.)

  2. CT-guided needle biopsy of lung lesions: A survey of severe complication based on 9783 biopsies in Japan

    Energy Technology Data Exchange (ETDEWEB)

    Tomiyama, Noriyuki [Department of Radiology, Osaka University Graduated School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 (Japan)]. E-mail: tomiyama@radiol.med.osaka-u.ac.jp; Yasuhara, Yoshifumi [Department of Radiology, National Hospital Organization Ehime National Hospital (Japan); Nakajima, Yasuo [Department of Radiology, St. Marianna University School of Medicine (Japan); Adachi, Shuji [Department of Radiology, Hyogo Medical Center for Adults (Japan); Arai, Yasuaki [Department of Diagnostic Radiology, National Cancer Center (Japan); Kusumoto, Masahiko [Department of Diagnostic Radiology, National Cancer Center (Japan); Eguchi, Kenji [Department of Oncology, Tokai University School of Medicine (Japan); Kuriyama, Keiko [Department of Radiology, Kinki Central Hospital of the Mutual Aid Association of Public School Teachers (Japan); Sakai, Fumikazu [Department of Radiology, Tokyo Metropolitan Komagome Hospital (Japan); Noguchi, Masayuki [Department of Pathology, Graduate School of Comprehensive Human Sciences, Institute of Basic Medical Sciences, University of Tsukuba (Japan); Murata, Kiyoshi [Department of Radiology, Shiga University of Medical Science (Japan); Murayama, Sadayuki [Faculty of Medicine, University of the Ryukyus (Japan); Mochizuki, Teruhito [Department of Radiology, Ehime University School of Medicine (Japan); Mori, Kiyoshi [Department of Thoracic Oncology, Tochigi Cancer Center (Japan); Yamada, Kozo [Department of Thoracic Oncology, Kanagawa Cancer Center (Japan)

    2006-07-15

    Purpose: The aim of our study was to update the rate of severe complications following CT-guided needle biopsy in Japan via a mailed survey. Materials and methods: Postal questionnaires regarding CT-guided needle biopsy were sent out to multiple hospitals in Japan. The questions regarded: the total number and duration of CT-guided lung biopsies performed at each hospital, and the complication rates and numbers of pneumothorax, hemothorax, air embolism, tumor seeding, tension pneumothorax and other rare complications. Each severe complication was followed with additional questions. Results: Data from 9783 biopsies was collected from 124 centers. Pneumothorax was the most common complication, and occurred in 2412 (35%) of 6881 cases. A total of 39 (35%) hospitals reported 74 (0.75%) cases with severe complications. There were six cases (0.061%) with air embolism, six cases (0.061%) with tumor seeding at the site of the biopsy route, 10 cases (0.10%) with tension pneumothorax, six cases (0.061%) with severe pulmonary hemorrhage or hemoptysis, nine cases (0.092%) with hemothorax, and 27 cases (0.26%) with others, including heart arrest, shock, and respiratory arrest. From a total of 62 patients with severe complications, 54 patients (0.55%) recovered without sequela, however one patient (0.01%) recovered with hemiplegia due to cerebral infarction, and the remaining seven patients (0.07%) died. Conclusions: This is the first national study documenting severe complications with respect to CT-guided needle biopsy in Japan. The complication rate in Japan is comparable to internationally published figures. We believe this data will improve both clinicians as well as patients understanding of the risk versus benefit of CT-guided needle biopsy, resulting better decisions.

  3. CT-guided vertebroplasty: analysis of technical results, extraosseous cement leakages, and complications in 500 procedures

    Energy Technology Data Exchange (ETDEWEB)

    Pitton, Michael Bernhard; Herber, Sascha; Koch, Ulrike; Oberholzer, Katja; Dueber, Christoph [Johannes Gutenberg-University of Mainz, Department of Diagnostic and Interventional Radiology, Mainz (Germany); Drees, Philip [University Hospital, Johannes Gutenberg-University of Mainz, Department of Orthopedic Surgery, Mainz (Germany)

    2008-11-15

    The aim of this study was to analyze the technical results, the extraosseous cement leakages, and the complications in our first 500 vertebroplasty procedures. Patients with osteoporotic vertebral compression fractures or osteolytic lesions caused by malignant tumors were treated with CT-guided vertebroplasty. The technical results were documented with CT, and the extraosseous cement leakages and periinterventional clinical complications were analyzed as well as secondary fractures during follow-up. Since 2002, 500 vertebroplasty procedures have been performed on 251 patients (82 male, 169 female, age 71.5 {+-} 9.8 years) suffering from osteoporotic compression fractures (n = 217) and/or malignant tumour infiltration (n = 34). The number of vertebrae treated per patient was 1.96 {+-} 1.29 (range 1-10); the numbers of interventions per patient and interventions per vertebra were 1.33 {+-} 0.75 (range 1-6) and 1.01 {+-} 0.10, respectively. The amount of PMMA cement was 4.5 {+-} 1.9 ml and decreased during the 5-year period of investigation. The procedure-related 30-day mortality was 0.4% (1 of 251 patients) due to pulmonary embolism in this case. The procedure-related morbidity was 2.8% (7/251), including one acute coronary syndrome beginning 12 h after the procedure and one missing patellar reflex in a patients with a cement leak near the neuroformen because of osteolytic destruction of the respective pedicle. Additionally, one patient developed a medullary conus syndrome after a fall during the night after vertebroplasty, two patients reached an inadequate depth of conscious sedation, and two cases had additional fractures (one pedicle fracture, one rib fracture). The overall CT-based cement leak rate was 55.4% and included leakages predominantly into intervertebral disc spaces (25.2%), epidural vein plexus (16.0%), through the posterior wall (2.6%), into the neuroforamen (1.6%), into paravertebral vessels (7.2%), and combinations of these and others. During follow

  4. Use of cone-beam CT and live 3-D needle guidance to facilitate percutaneous nephrostomy and nephrolithotripsy access in children and adolescents

    Energy Technology Data Exchange (ETDEWEB)

    Hawkins, C.M. [Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, GA (United States); Kukreja, Kamlesh [Texas Children' s Hospital, Department of Radiology, Houston, TX (United States); Singewald, Timothy; Johnson, Neil D.; Racadio, John M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Minevich, Eugene; Reddy, Pramod [Cincinnati Children' s Hospital Medical Center, Department of Urology, Cincinnati, OH (United States)

    2016-04-15

    Gaining access into non-dilated renal collecting systems for percutaneous nephrolithotripsy, particularly in patients with prohibitive body habitus and/or scoliosis, is often challenging using conventional techniques. To evaluate the feasibility of cone-beam CT for percutaneous nephrostomy placement for subsequent percutaneous nephrolithotripsy in children and adolescents. A retrospective review of percutaneous nephrostomy revealed use of cone-beam CT and 3-D guidance in 12 percutaneous nephrostomy procedures for 9 patients between 2006 and 2015. All cone-beam CT-guided percutaneous nephrostomies were for pre-lithotripsy access and all 12 were placed in non-dilated collecting systems. Technical success was 100%. There were no complications. Cone-beam CT with 3-D guidance is a technically feasible technique for percutaneous nephrostomy in children and adolescents, specifically for nephrolithotripsy access in non-dilated collecting systems. (orig.)

  5. CT-guided bone cement injection combined with artificial tiger bone meal to repair osteoporotic vertebral compression fractures:callus growth and bone healing%CT引导下骨水泥注入辅助人工虎骨粉修复骨质疏松性脊椎压缩性骨折:骨痂生长及骨愈合评价

    Institute of Scientific and Technical Information of China (English)

    闵朋; 张燕萍; 曹洪

    2015-01-01

      结果与结论:观察组术后骨痂生长良好,多为Ⅲ级与Ⅳ级患者;显著优于对照组(P OBJECTIVE:To observe calus formation and fracture healing in patients with osteoporotic vertebral compression fractures repaired by CT-guided minimaly invasive surgery with bone cement injection and artificial tiger bone meal. METHODS:A total of 85 cases of osteoporotic vertebral compression fractures were selected. Patients were randomly divided into observation group (n=43) and control group (n=42). Patients in the observation and control groups respectively received CT-guided minimaly invasive percutaneous vertebroplasty, matching with artificial tiger bone meal andJiegu Qili pil. Calus growth, fracture healing and pain relief time were observed in the two groups. RESULTS AND CONCLUSION:The calus growth was good in patients of the observation group, mainly grade III and IV, and significantly better than in the control group (P < 0.05). Pain relief time and healing time were significantly shorter in the observation group than in the control group (P < 0.05). The excelent and good rate of Japanese Orthopaedic Association score was significantly better in the observation group than in the control group (P < 0.05). These results suggested that CT-guided minimaly invasive percutaneous vertebroplasty in the combination with bone cement injection for osteoporotic vertebral compression fractures can obtain evident effects. The combined use of artificial tiger bone meal has a good promoting effect on fracture healing.

  6. CT-guided spinal injection: initial experience with Sprotte tip needles

    Energy Technology Data Exchange (ETDEWEB)

    Pua, Uei [Tan Tock Seng Hospital, Department of Diagnostic Radiology, Singapore (Singapore)

    2010-09-15

    The purpose of this paper is to describe our initial experience and to illustrate the potential benefits of using small caliber (25 and 27 G), noncutting pencil point needles (Sprotte) with single puncture coaxial technique in CT-guided spinal intervention (CTSI). From January 2009 to June 2009, Sprotte needles with single puncture coaxial technique were used in a total of ten patients for selective nerve root block (SNRB), facet joint block, and pars block under CT fluoroscopy (total of 16 target structures). All procedures were performed without conscious sedation, and visual analog scale (VAS) scores were recorded to determine pain related to needle placement. Total CT fluoroscopy time and out-of-plane needle deviation were obtained. Final needle position was documented by contrast injection for SNRBs and image capture for joint space cannulation. Sixteen out of the 16 structures were successfully targeted. No increase in VAS scores associated with needle placement was recorded, after infiltration of local anesthesia. Optimal peri-neurograms were obtained in all cases of SNRB, despite the side-hole opening in the Sprotte needles. Mean CT fluoroscopy time was 2 s (range 2-8 s per structure), and there was no case of out-of-plane needle deviation that required adjustment of the CT gantry. The use of small caliber Sprotte needles in CTSI is technically feasible and represents a potential refinement to current techniques in the management of chronic spinal pain. (orig.)

  7. CT-guided stereotaxic implantation of Ommaya reservoir for cystic brain tumor

    Energy Technology Data Exchange (ETDEWEB)

    Nakasato, Nobukazu; Niizuma, Hiroshi; Johkura, Hidefumi; Katoh, Seiya; Otsuki, Taisuke; Katakura, Ryuichi; Suzuki, Jiro

    1988-02-01

    We report the use of CT-guided stereotaxic system to implant Ommaya reservoir in 26 patients with cystic brain tumors consisting of 16 gliomas, 3 craniopharyngiomas, 3 metastatic brain tumors and 5 other and unknown pathologies, on the way of their biopsy. The entire procedure was carried out in the CT room using Leksell's CT stereotaxic system. In 24 cases with supratentorial tumors, it was at the option of the operator to take any approach such as frontal, posterior temporal and parietal approaches. Especially in 3 cases of craniopharyngioma, we inserted the tube into their cyst directly so that the ventricle should not be open to the cyst. Also in cases of a pontine glioma and a C-P angle metastatic tumor, we used retromastoid approach to the posterior fossa by making patient's heads turned about 30 to 40 deg to contralateral side of the approach, with slight flexion of the neck. Minimal bleeding occurred during operation in one case, however, it showed no clinical symptoms. Advantages of this method are as follows: Operative invasion is minimal; The surgeon can check the course of the cannula and position of the tip of Ommaya tube even at operation, and can modify it, if necessary.

  8. CT-guided biopsies and drainage; CT-gesteuerte Punktionen und Drainagen

    Energy Technology Data Exchange (ETDEWEB)

    Scheppers, I.; Wollschlaeger, D. [Staedtisches Klinikum Karlsruhe gGmbH, Zentralinstitut fuer Bildgebende Diagnostik, Karlsruhe (Germany)

    2011-11-15

    Following the implementation of computed tomography (CT) or ultrasound-guided biopsy of solid tumors and the puncture and drainage of liquid processes, the number of surgical open biopsies and curative operations for abscess drainage has declined. Such CT-guided interventions are performed in nearly every organ. Instead of aspiration biopsies, more and more core biopsies are being performed to allow histopathological evaluation and thus allowing targeted therapy. This article is intended to give a general overview of techniques, materials, indications and contraindications. Ultrasound-guided biopsies as well as large bore vacuum biopsies of the breast are not included in this review. (orig.) [German] Infolge der Durchfuehrung von bildgesteuerten Biopsien solider Raumforderungen und Punktionen mit Drainageeinlage bei liquiden Prozessen ist die Zahl chirurgischer Exzisionsbiopsien und Abszesssanierungen zurueckgegangen. Diese Eingriffe werden in nahezu allen Organgebieten durchgefuehrt. Neben den Aspirationsbiopsien werden haeufig Schneid- oder Stanzbiopsien durchgefuehrt. Nach histologischer und immunhistologischer Untersuchung der hierbei gewonnenen Proben in der Pathologie kann fruehzeitig die nachfolgende Therapie geplant werden. Der vorliegende Beitrag soll einen allgemeinen Ueberblick ueber Methoden, Materialien, Indikationen und Kontraindikationen geben. Die ultraschallgesteuerten Biopsien sowie die Vakuumsaugbiopsien im Rahmen des Mammographiescreenings werden bewusst nicht besprochen. (orig.)

  9. Augmented reality system for CT-guided interventions: system description and initial phantom trials

    Science.gov (United States)

    Sauer, Frank; Schoepf, Uwe J.; Khamene, Ali; Vogt, Sebastian; Das, Marco; Silverman, Stuart G.

    2003-05-01

    We are developing an augmented reality (AR) image guidance system, in which information derived from medical images is overlaid onto a video view of the patient. The interventionalist wears a head-mounted display (HMD) that presents him with the augmented stereo view. The HMD is custom fitted with two miniature color video cameras that capture the stereo view of the scene. A third video camera, operating in the near IR, is also attached to the HMD and is used for head tracking. The system achieves real-time performance of 30 frames per second. The graphics appears firmly anchored in the scne, without any noticeable swimming or jitter or time lag. For the application of CT-guided interventions, we extended our original prototype system to include tracking of a biopsy needle to which we attached a set of optical markers. The AR visualization provides very intuitive guidance for planning and placement of the needle and reduces radiation to patient and radiologist. We used an interventional abdominal phantom with simulated liver lesions to perform an inital set of experiments. The users were consistently able to locate the target lesion with the first needle pass. These results provide encouragement to move the system towards clinical trials.

  10. CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip

    Energy Technology Data Exchange (ETDEWEB)

    Heywang-Koebrunner, S.H.; Amaya, B.; Pickuth, D.; Spielmann, R.P. [Dept. of Diagnostic Radiology, Martin-Luther University Halle-Wittenberg (Germany); Okoniewski, M. [Dept. of Orthopaedics, Martin-Luther University Halle-Wittenberg (Germany)

    2001-06-01

    Obturator nerve blocks (ONB) have been performed by anaesthesiologists mainly to eliminate the obturator reflex during transurethral resections. An effect on hip pain has also been described. However, being a time-consuming and operator-dependent procedure if performed manually, it has not been widely used for chronic hip pain. The purpose of this pilot study was to check whether CT guidance could improve reproducibility of the block (= immediate effect) and to test its potential value for treatment of chronic hip pain. Fifteen chronically ill patients with osteoarthritis underwent a single ONB. Sixteen millilitres of Lidocaine 1 % mixed with 2 ml Iopramide was injected into the obturator canal. The patients were followed up to 9 months after the intervention. With a single injection pain relief was achieved for 1-8 weeks in 7 of 15 patients. Excellent pain relief for 3-11 months was achieved in another 4 patients. Reasons for a mid-term or even long-term effect based on a single injection of local anaesthetic are not exactly known. The CT-guided ONB is a fast, easy and safe procedure that may be useful for mid-term (weeks) and sometimes even long-term (months) treatment of hip pain. (orig.)

  11. CT-guided {sup 125}I brachytherapy for mediastinal metastatic lymph nodes recurrence from esophageal carcinoma: Effectiveness and safety in 16 patients

    Energy Technology Data Exchange (ETDEWEB)

    Gao, Fei, E-mail: gaof@sysucc.org.cn [State Key Laboratory of Oncology in South China, Guangzhou 510060 (China); Department of Interventional Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060 (China); Li, Chuanxing, E-mail: licx@sysucc.org.cn [State Key Laboratory of Oncology in South China, Guangzhou 510060 (China); Department of Interventional Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060 (China); Gu, Yangkui, E-mail: guyk@sysucc.org.cn [State Key Laboratory of Oncology in South China, Guangzhou 510060 (China); Department of Interventional Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060 (China); Huang, Jinhua, E-mail: huangjh@sysucc.org.cn [State Key Laboratory of Oncology in South China, Guangzhou 510060 (China); Department of Interventional Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060 (China); Wu, Peihong, E-mail: vivian-link@163.com [State Key Laboratory of Oncology in South China, Guangzhou 510060 (China); Department of Interventional Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060 (China)

    2013-02-15

    Objectives: To retrospectively evaluate effectiveness and safety of CT-guided {sup 125}I brachytherapy in 16 patients with mediastinal metastatic lymph nodes recurrence from esophageal carcinoma. Materials and methods: Sixteen metastatic lymph nodes in 16 patients were percutaneously treated in 19 {sup 125}I brachytherapy sessions. Each metastatic lymph node was treated with computed tomographic (CT) guidance. Follow-up contrast material-enhanced CT or positron emission tomographic (PET) scans were reviewed and the treatment's effectiveness was evaluated. Results: Months are counted from the first time of {sup 125}I brachytherapy and the median duration of follow-up was 11 months (range, 5–16 months). The local control rates after 3, 6, 10 and 15 months were 75.0, 50.0, 42.9 and 33.3% respectively. At the time of writing, four patients are alive without evidence of recurrence at 16, 9, 16 and 9 months. The 4 patients presented good control of local tumor and no systemic recurrence, and survived throughout the follow-up period. The other 12 patients died of multiple hematogenous metastases 5–15 months after brachytherapy. A small amount of local hematoma occurred in 2 patients that involved applicator insertion through the lung. Two patients presented pneumothorax with pulmonary compression of 30 and 40% after the procedure and recovered after drainage. One patient had minor displacement of radioactive seeds. Severe complications such as massive bleeding and radiation pneumonitis did not occur. Conclusion: {sup 125}I radioactive seed implantation is effective and may be safely applied to mediastinal metastatic lymph nodes recurrence from esophageal carcinoma.

  12. CT-guided screw fixation of vertical sacral fractures in local anaesthesia using a standard CT; CT-kontrollierte Schraubenosteosynthese von vertikalen Frakturen des hinteren Beckenringes in Lokalanaesthesie

    Energy Technology Data Exchange (ETDEWEB)

    Reuther, G.; Dehne, I. [Thueringen-Klinik, Saalfeld (Germany). Radiologische Klinik; Roehner, U.; Will, T.; Petereit, U. [Thueringen-Klinik, Saalfeld (Germany). Orthopaedics and Trauma Surgery

    2014-12-15

    To evaluate time efficiency, radiation dose, precision and complications of percutaneous iliosacral screw placement under CT-guidance in local anaesthesia. Retrospective analysis of 143 interventions in 135 patients during a period of 42 months. Implant failures could be evaluated in 85/182 screws and bony healing or refracturing in 46/182 screws. A total of 182 iliosacral screw placements in 179 vertical sacral fractures (105 unilateral, 37 bilateral) took place in 135 patients. 166/179 of the sacral fractures were detected in Denis zone 1, 10 in Denis zone 2 and 3 in Denis zone 3. No screw misplacements including the simultaneous bilateral procedures were noted. The average time for a unilateral screw placement was 23 minutes (range: 14-52 minutes) and 35 minutes (range: 21-60 minutes) for simultaneous bilateral screwing. The dose length product was 365 mGy x cm (range: 162-1014 mGy x cm) for the unilateral and 470 mGy x cm (range: 270-1271 mGy x cm) for the bilateral procedure. 1 gluteal bleeding occurred as the only acute minor complication (0.7%). Fracture healing was verified with follow-up CTs in 42/46 sacral fractures after screw placement. Backing out occurred in 12/85 screws between 6 and 69 days after intervention. In 8 patients contralateral stress fractures were detected after unilateral screw placement between day 10 and 127 (average: 48 days). CT-guided iliosacral screw placement in sacral fractures is a safe tool providing a very high precision. The radiation dose is in the order of a diagnostic CT of the pelvis for both unilateral and bilateral screws. Contralateral stress fractures in unilateral screw placements have to be considered during the first weeks after intervention.

  13. CT-Guided Biopsy in Suspected Spondylodiscitis--The Association of Paravertebral Inflammation with Microbial Pathogen Detection.

    Directory of Open Access Journals (Sweden)

    Daniel Spira

    Full Text Available To search for imaging characteristics distinguishing patients with successful from those with futile microbiological pathogen detection by CT-guided biopsy in suspected spondylodiscitis.34 consecutive patients with suspected spondylodiscitis underwent CT-guided biopsy for pathogen detection. MR-images were assessed for inflammatory infiltration of disks, adjacent vertebrae, epidural and paravertebral space. CT-images were reviewed for arrosion of adjacent end plates and reduced disk height. Biopsy samples were sent for microbiological examination in 34/34 patients, and for additional histological analysis in 28/34 patients.Paravertebral infiltration was present in all 10/10 patients with positive microbiology and occurred in only 12/24 patients with negative microbiology, resulting in a sensitivity of 100% and a specificity of 50% for pathogen detection. Despite its limited sensitivities, epidural infiltration and paravertebral abscesses showed considerably higher specificities of 83.3% and 90.9%, respectively. Paravertebral infiltration was more extensive in patients with positive as compared to negative microbiology (p = 0.002. Even though sensitivities for pathogen detection were also high in case of vertebral and disk infiltration, or end plate arrosion, specificities remained below 10%.Inflammatory infiltration of the paravertebral space indicated successful pathogen detection by CT-guided biopsy. Specificity was increased by the additional occurrence of epidural infiltration or paravertebral abscesses.

  14. The short- and medium-term effectiveness of CT-guided selective cervical nerve root injection for pain and disability

    Energy Technology Data Exchange (ETDEWEB)

    Desai, Amidevi; Saha, Shouvik; Sharma, Naveen; Huckerby, Lauren; Houghton, Russell [Guy' s and St. Thomas' Hospitals, Department of Radiology, London (United Kingdom)

    2014-07-15

    CT-guided cervical nerve root injection with corticosteroid and/or local anesthetic is a recognized technique in the evaluation and treatment of cervical radiculopathy. There are few prospective studies on the efficacy of the various techniques employed in cervical nerve root injection. We present our results from a 1-year prospective series using a CT-guided anterolateral transforaminal approach for cervical nerve root injection of bupivacaine and dexamethasone. Pain using a numeric rating scale was assessed at pre-injection, 15 min post-injection, 1 month, and 3 months. Disability was assessed using the Oswestry Neck Disability Index (NDI) questionnaire at pre-injection, 1 month post-injection, and 3 months. In total, 50 patients were followed for 3 months. The mean reductions in pain were: 15 min (77 %), 1 month (39 %), and 3 months (33 %). The mean reductions in NDI were: 1 month (26 %) and 3 months (also 26 %). Results were statistically significant. CT-guided selective cervical nerve root injection in the treatment of cervical radicular pain and related disability produces statistically significant reductions in pain and disability to at least 3 months post-procedure. (orig.)

  15. CT-guided bone biopsy: Initial experience with a commercially available hand held Black and Decker{sup TM} drill

    Energy Technology Data Exchange (ETDEWEB)

    Buckley, O. [Department of Radiology, Adelaide and Meath, Hospital, Tallaght, Dublin 24 (Ireland); Benfayed, W. [Department of Radiology, Adelaide and Meath, Hospital, Tallaght, Dublin 24 (Ireland); Geoghegan, T. [Department of Radiology, Adelaide and Meath, Hospital, Tallaght, Dublin 24 (Ireland); Al-Ismail, K. [Department of Radiology, King Faisal Hospital (Saudi Arabia); Munk, P.L. [Department of Radiology, Musculo-Skeletal division, Vancouver General Hospital, 899 W. 12th Ave., Vancouver, BC V5Z 1M9 (Canada); Torreggiani, William C. [Department of Radiology, Adelaide and Meath, Hospital, Tallaght, Dublin 24 (Ireland)]. E-mail: william.torreggiani@amnch.ie

    2007-01-15

    Purpose: To describe the use of a simple commercially available Black and Decker{sup TM} hand based drill in performing CT-guided bone biopsies. Materials and methods: Three international institutions were enrolled in the study. In each centre, a fellowship trained musculoskeletal radiologist directed the assessment of a hand based commercial drill for performing CT-guided bone biopsies. A specially designed component was engineered which allowed the connection of a standard bone biopsy set to a commercial drill. The component was distributed to the three centres involved. Over a 3-year period, data from all three institutions was collected. Information regarding technical success, diagnostic data and complication rates were all collated to assess the technical feasibility of this technique. Results: In total 68 patients underwent bone biopsy using a hand held commercial drill. Technical success was achieved in 65 patients. Diagnostic material was obtained in 53 patients. Non-diagnostic material was obtained in 12 patients. Five out of the 12 patients with non-diagnostic material had repeat biopsies with diagnostic material obtained in 2 of these. No major complications occurred in any patient. Conclusion: CT-guided bone biopsy using a hand held commercial drill has a technically high success rate with minimal complications.

  16. Three-dimensional C-arm CT-guided transjugular intrahepatic portosystemic shunt placement: Feasibility, technical success and procedural time

    Energy Technology Data Exchange (ETDEWEB)

    Ketelsen, Dominik; Groezinger, Gerd; Maurer, Michael; Grosse, Ulrich; Horger, Marius; Nikolaou, Konstantin; Syha, Roland [University of Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Lauer, Ulrich M. [University of Tuebingen, Internal Medicine I, Department of Gastroenterology, Hepatology and Infectious disease, Tuebingen (Germany)

    2016-12-15

    Establishment of transjugular intrahepatic portosystemic shunts (TIPS) constitutes a standard procedure in patients suffering from portal hypertension. The most difficult step in TIPS placement is blind puncture of the portal vein. This study aimed to evaluate three-dimensional mapping of portal vein branches and targeted puncture of the portal vein. Twelve consecutive patients suffering from refractory ascites by liver cirrhosis were included in this retrospective study to evaluate feasibility, technical success and procedural time of C-arm CT-targeted puncture of the portal vein. As a control, 22 patients receiving TIPS placement with fluoroscopy-guided blind puncture were included to compare procedural time. Technical success could be obtained in 100 % of the study group (targeted puncture) and in 95.5 % of the control group (blind puncture). Appropriate, three-dimensional C-arm CT-guided mapping of the portal vein branches could be achieved in all patients. The median number of punctures in the C-arm CT-guided study group was 2 ± 1.3 punctures. Procedural time was significantly lower in the study group (14.8 ± 8.2 min) compared to the control group (32.6 ± 22.7 min) (p = 0.02). C-arm CT-guided portal vein mapping is technically feasible and a promising tool for TIPS placement resulting in a significant reduction of procedural time. (orig.)

  17. Palliative Treatment of Rectal Carcinoma Recurrence Using Radiofrequency Ablation

    Energy Technology Data Exchange (ETDEWEB)

    Mylona, Sophia, E-mail: mylonasophia@yahoo.com; Karagiannis, Georgios, E-mail: gekaragiannis@yahoo.gr; Patsoura, Sofia, E-mail: sofia.patsoura@yahoo.gr [Hellenic Red Cross Hospital ' Korgialenio-Benakio' (Greece); Galani, Panagiota, E-mail: gioulagalani@yahoo.com [Amalia Fleming Hospital (Greece); Pomoni, Maria, E-mail: marypomoni@gmail.com [Evgenidion Hospital (Greece); Thanos, Loukas, E-mail: loutharad@yahoo.com [Sotiria Hospital (Greece)

    2012-08-15

    Purpose: To evaluate the safety and efficacy of CT-guided radiofrequency (RF) ablation for the palliative treatment of recurrent unresectable rectal tumors. Materials and Methods: Twenty-seven patients with locally recurrent rectal cancer were treated with computed tomography (CT)-guided RF ablation. Therapy was performed with the patient under conscious sedation with a seven- or a nine-array expandable RF electrode for 8-10 min at 80-110 Degree-Sign C and a power of 90-110 W. All patients went home under instructions the next day of the procedure. Brief Pain Inventory score was calculated before and after (1 day, 1 week, 1 month, 3 months, and 6 months) treatment. Results: Complete tumor necrosis rate was 77.8% (21 of a total 27 procedures) despite lesion location. BPI score was dramatically decreased after the procedure. The mean preprocedure BPI score was 6.59, which decreased to 3.15, 1.15, and 0.11 at postprocedure day 1, week 1, and month 1, respectively, after the procedure. This decrease was significant (p < 0.01 for the first day and p < 0.001 for the rest of the follow-up intervals (paired Student t test; n - 1 = 26) for all periods during follow-up. Six patients had partial tumor necrosis, and we were attempted to them with a second procedure. Although the necrosis area showed a radiographic increase, no complete necrosis was achieved (secondary success rate 65.6%). No immediate or delayed complications were observed. Conclusion: CT-guided RF ablation is a minimally invasive, safe, and highly effective technique for treatment of malignant rectal recurrence. The method is well tolerated by patients, and pain relief is quickly achieved.

  18. Design and validation of a CT-guided robotic system for lung cancer brachytherapy.

    Science.gov (United States)

    Dou, Huaisu; Jiang, Shan; Yang, Zhiyong; Sun, Luqing; Ma, Xiaodong; Huo, Bin

    2017-09-01

    Currently, lung brachytherapy in clinical setting is a complex procedure. Operation accuracy depends on accurate positioning of the template; however, it is difficult to guarantee the positioning accuracy manually. Application of robotic-assisted systems can simplify the procedure and improve the manual positioning accuracy. Therefore, a novel CT-guided robotic system was developed to assist the lung cancer brachytherapy. A four degree-of-freedom (DOF) robot, controlled by a lung brachytherapy treatment planning system (TPS) software, was designed and manufactured to assist the template positioning. Target position of the template can be obtained from the treatment plan, thus the robot is driven to the target position automatically. The robotic system was validated in both the laboratory and the CT environment. In laboratory environment, a 3D laser tracker and an inertial measurement unit (IMU) were used to measure the mechanical accuracy in air, which includes positioning accuracy and position repeatability. Working reliability was also validated in this procedure by observing the response reliability and calculating the position repeatability. Imaging artifacts and accuracy of the robot registration were validated in the CT environment by using an artificial phantom with fiducial markers. CT images were obtained and used to test the image artifact and calculate the registration accuracy. Phantom experiments were conducted to test the accuracy of needle insertion by using a transparent hydrogel phantom with a high imitation artificial phantom. Also, the efficiency was validated in this procedure by comparing time costs in manual positioning with robotic positioning under the same experimental conditions. The robotic system achieved the positioning accuracy of 0.28 ± 0.25 mm and the position repeatability of 0.09 ± 0.11 mm. Experimental results showed that the robot was CT-compatible and responded reliably to the control commands. The mean registration accuracy

  19. Accessible or Inaccessible? Diagnostic Efficacy of CT-Guided Core Biopsies of Head and Neck Masses

    Energy Technology Data Exchange (ETDEWEB)

    Cunningham, Jane D., E-mail: janecunningham0708@gmail.com; McCusker, Mark W.; Power, Sarah; PearlyTi, Joanna; Thornton, John; Brennan, Paul; Lee, Michael J.; O’Hare, Alan; Looby, Seamus [Beaumont Hospital, Department of Radiology (Ireland)

    2015-04-15

    PurposeTissue sampling of lesions in the head and neck is challenging due to complex regional anatomy and sometimes necessitates open surgical biopsy. However, many patients are poor surgical candidates due to comorbidity. Thus, we evaluated the use of CT guidance for establishing histopathological diagnosis of head and neck masses.MethodsAll consecutive patients (n = 22) who underwent CT-guided core biopsy of head or neck masses between April 2009 and August 2012 were retrospectively reviewed using the departmental CT interventional procedures database. The indication for each biopsy performed was to establish or exclude a diagnosis of neoplasia in patients with suspicious head or neck lesions found on clinical examination or imaging studies. Patients received conscious sedation and 18 G, semiautomated core needle biopsies were performed by experienced neuroradiologists using 16-slice multidetector row CT imaging guidance (Somatom Definition Siemens Medical Solutions, Germany). Histopathology results of each biopsy were analysed.ResultsSixteen of 22 biopsies that were performed (73 %) yielded a pathological diagnosis. Anatomic locations biopsied included: masticator (n = 7), parapharyngeal (n = 3), parotid (n = 3), carotid (n = 3), perivertebral (n = 3), pharyngeal (n = 2), and retropharyngeal (n = 1) spaces. Six biopsies (27 %) were nondiagnostic due to inadequate tissue sampling, particularly small biopsy sample size and failure to biopsy the true sampling site due to extensive necrosis. No major complications were encountered.ConclusionsThe use of CT guidance to perform core biopsies of head and neck masses is an effective means of establishing histopathological diagnosis and reduces the need for diagnostic open surgical biopsy and general anaesthesia.

  20. CT -guided sclerotherapy for simple renal cysts: Value of ethanol concentration monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Jin Hong; Du, Yong; Li, Yang; Yang, Han Feng; Xu, Xiao Xue; Zheng, Hou Jun [The Affiliated Hospital of North Sichuan Medical College, Nanchong (China)

    2014-02-15

    The aim of our study was to evaluate the differences between sclerotherapy with and without ethanol concentration monitoring for the treatment of simple renal cysts. Sixty-seven patients with 70 simple renal cysts were randomly assigned to two groups in a 12-month prospective controlled trial. One group (group A) was treated with computed tomography (CT)-guided sclerotherapy without ethanol concentration monitoring (33 patients with 35 cysts), whereas the other group (group B) had ethanol concentration monitoring (34 patients with 35 cysts) during the procedure. Treatment outcomes between the two groups were compared 12 months later with follow-up ultrasound examination. After the 12-month follow-up period, the overall success rate was 74.3% in group A and 94.3% in group B (p = 0.022). The mean cyst size before and after treatment was 8.6 ± 2.0 cm and 2.3 ± 2.9 cm, respectively, in group A, and 8.4 ± 1.7 cm and 0.8 ± 1.9 cm, respectively, in group B. The final size of the cysts in group B was significantly smaller than that in group A (p = 0.015). The likelihood of treatment with ethanol concentration monitoring being successful was approximately 16 times higher than without ethanol concentration monitoring (p = 0.026; odds ratio = 15.7; 95% confidence interval: 1.38-179.49). There were no major complications in either group. Monitoring of Hounsfield units (HU) of ethanol by CT is an effective method in the treatment of simple renal cysts with ethanol sclerotherapy. The ethanol sclerotherapy procedure can be terminated at the point of clear fluid aspiration because the HU (-190) of CT scan corresponds to it.

  1. CT-guided biopsy of thoracic lesions with a novel wire-based needle guide device - initial experiences

    Energy Technology Data Exchange (ETDEWEB)

    Kroepil, Patric; Bilk, Philip; Quentin, Michael; Miese, Falk R; Lanzman, Rotem S; Scherer, Axel (Dept. of Radiology, Medical Faculty, Univ. Duesseldorf, Duesseldorf (Germany)), email: Patric.Kroepil@med.uni-duesseldorf.de

    2011-10-15

    Background Biopsies guided by computed tomography (CT) play an important role in clinical practice. A short duration, minimal radiation dose and complication rate are of particular interest. Purpose To evaluate the potential of a novel self-manufactured wire-based needle guide device for CT-guided thoracic biopsies with respect to radiation dose, intervention time and complication rate. Material and Methods Forty patients that underwent CT-guided biopsies of thoracic lesions were included in this study and assigned to two groups. Patients in group A (n = 20, mean age 69 +- 8.4 years) underwent biopsies with a novel wire-based needle guide device, while patients in group B (n = 20, mean age 68.4 +- 10.1 years) were biopsied without a needle guide device. The novel self-manufactured needle guide device consists of an iron/zinc wire modelled to a ring with a flexible arm and an eye at the end of the arm to stabilize the biopsy needle in the optimal position during intervention. Predefined parameters (radiation dose, number of acquired CT-slices, duration of intervention, complications) were compared between both groups. Results Mean radiation dose (CTDIvol 192 mGy versus 541 mGy; P = 0.001) and the number of acquired slices during intervention (n = 49 +- 33 vs. n = 126 +- 78; P = 0.001) were significantly lower in group A compared with group B. Intervention time in group A (13.1 min) was significantly lower than in group B (18.5 min, P < 0.01). A pneumothorax as peri-interventional complication was observed less frequent after device assisted biopsies (n = 4 vs. n = 8, n.s.). Conclusion The novel wire-based needle guide device is a promising tool to facilitate CT-guided thoracic biopsies reducing radiation dose, intervention time, and related complications. Further studies are mandatory to confirm these initial results

  2. Renal Sympathetic Denervation by CT-Guided Ethanol Injection: A Phase II Pilot Trial of a Novel Technique

    Energy Technology Data Exchange (ETDEWEB)

    Ricke, J., E-mail: jens.ricke@med.ovgu.de; Seidensticker, M.; Becker, S. [Otto-von-Guericke University Magdeburg, Department of Radiology and Nuclear Medicine, Universitätsklinikum Magdeburg AöR (Germany); Schiefer, J. [Universitätsklinikum Magdeburg AöR, Department of Nephrology and Hypertension, Diabetes and Endocrinology (Germany); Adamchic, I.; Lohfink, K. [Otto-von-Guericke University Magdeburg, Department of Radiology and Nuclear Medicine, Universitätsklinikum Magdeburg AöR (Germany); Kandulski, M.; Heller, A.; Mertens, P. R. [Universitätsklinikum Magdeburg AöR, Department of Nephrology and Hypertension, Diabetes and Endocrinology (Germany)

    2016-02-15

    ObjectivesCT-guided ethanol-mediated renal sympathetic denervation in treatment of therapy-resistant hypertension was performed to assess patient safety and collect preliminary data on treatment efficacy.Materials and MethodsEleven patients with therapy-resistant hypertension (blood pressure of >160 mmHg despite three different antihypertensive drugs including a diuretic) and following screening for secondary causes were enrolled in a phase II single arm open label pilot trial of CT-guided neurolysis of sympathetic renal innervation. Primary endpoint was safety, and secondary endpoint was a decrease of the mean office as well as 24-h systolic blood pressure in follow-up. Follow-up visits at 4 weeks, 3, and 6 months included 24-h blood pressure assessments, office blood pressure, laboratory values, as well as full clinical and quality of life assessments.ResultsNo toxicities ≥3° occurred. Three patients exhibited worsened kidney function in follow-up analyses. When accounting all patients, office systolic blood pressure decreased significantly at all follow-up visits (maximal mean decrease −41.2 mmHg at 3 months). The mean 24-h systolic blood pressure values decreased significantly at 3 months, but not at 6 months (mean: −9.7 and −6.3 mmHg, respectively). Exclusion of five patients who had failed catheter-based endovascular denervation and/or were incompliant for antihypertensive drug intake revealed a more pronounced decrease of 24-h systolic blood pressure (mean: −18.3 and −15.2 mmHg at 3 and 6 months, p = 0.03 and 0.06).ConclusionCT-guided sympathetic denervation proved to be safe and applicable under various anatomical conditions with more renal arteries and such of small diameter.

  3. Evaluation of chronic infectious interstitial pulmonary disease in children by low-dose CT-guided transthoracic lung biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Heyer, Christoph M.; Lemburg, Stefan P.; Kagel, Thomas; Nicolas, Volkmar [Ruhr-University of Bochum, Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, BG Clinics Bergmannsheil, Bochum (Germany); Mueller, Klaus-Michael [Ruhr-University of Bochum, Institute of Pathology, BG Clinics Bergmannsheil, Bochum (Germany); Nuesslein, Thomas G.; Rieger, Christian H.L. [Ruhr-University of Bochum, Pediatric Hospital, Bochum (Germany)

    2005-07-01

    Children with chronic infectious interstitial lung disease often have to undergo open lung biopsy to establish a final diagnosis. Open lung biopsy is an invasive procedure with major potential complications. Transthoracic lung biopsy (TLB) guided by computed tomography (CT) is a less-invasive well-established procedure in adults. Detailing the role of low-dose CT-guided TLB in the enhanced diagnosis of chronic lung diseases related to infection in children. A group of 11 children (age 8 months to 16 years) underwent CT-guided TLB with a 20-gauge biopsy device. All investigations were done under general anaesthesia on a multidetector CT scanner (SOMATOM Volume Zoom, Siemens, Erlangen, Germany) using a low-dose protocol (single slices, 120 kV, 20 mAs). Specimens were processed by histopathological, bacteriological, and virological techniques. All biopsies were performed without major complications; one child developed a small pneumothorax that resolved spontaneously. A diagnosis could be obtained in 10 of the 11 patients. Biopsy specimens revealed chronic interstitial alveolitis in ten patients. In five patients Chlamydia pneumoniae PCR was positive, in three Mycoplasma pneumoniae PCR was positive, and in two Cytomegalovirus PCR was positive. The average effective dose was 0.83 mSv. Low-dose CT-guided TLB can be a helpful tool in investigating chronic infectious inflammatory processes in children with minimal radiation exposure. It should be considered prior to any open surgical procedure performed for biopsy alone. In our patient group no significant complication occurred. A disadvantage of the method is that it does not allow smaller airways and vessels to be assessed. (orig.)

  4. Pneumothorax Complicating Coaxial and Non-coaxial CT-Guided Lung Biopsy: Comparative Analysis of Determining Risk Factors and Management of Pneumothorax in a Retrospective Review of 650 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Nour-Eldin, Nour-Eldin A., E-mail: nour410@hotmail.com; Alsubhi, Mohammed, E-mail: mohammedal-subhi@yahoo.com; Emam, Ahmed, E-mail: morgan101002@hotmail.com; Lehnert, Thomas, E-mail: thomas.lehnert@kgu.de; Beeres, Martin, E-mail: beeres@gmx.net; Jacobi, Volkmar, E-mail: volkmar.jacobi@kgu.de; Gruber-Rouh, Tatjana, E-mail: tatjanagruber2004@yahoo.com; Scholtz, Jan-Erik, E-mail: janerikscholtz@gmail.com; Vogl, Thomas J., E-mail: t.vogl@em.uni-frankfurt.de; Naguib, Nagy N., E-mail: nagynnn@yahoo.com [Johan Wolfgang Goethe – University Hospital, Institute for Diagnostic and Interventional Radiology (Germany)

    2016-02-15

    PurposeTo assess the scope and determining risk factors related to the development of pneumothorax throughout CT-guided biopsy of pulmonary lesions in coaxial and non-coaxial techniques and the outcome of its management.Materials and MethodsThe study included CT-guided percutaneous lung biopsies in 650 consecutive patients (407 males, 243 females; mean age 54.6 years, SD 5.2) from November 2008 to June 2013 in a retrospective design. Patients were classified according to lung biopsy technique into coaxial group (318 lesions) and non-coaxial group (332 lesions). Exclusion criteria for biopsy were lesions <5 mm in diameter, uncorrectable coagulopathy, positive-pressure ventilation, severe respiratory compromise, pulmonary arterial hypertension, or refusal of the procedure. Risk factors related to the occurrence of pneumothorax were classified into: (a) Technical risk factors, (b) patient-related risk factors, and (c) lesion-associated risk factors. Radiological assessments were performed by two radiologists in consensus. Mann–Whitney U test and Fisher’s exact tests were used for statistical analysis. p values <0.05 were considered statistically significant.ResultsThe incidence of pneumothorax complicating CT-guided lung biopsy was less in the non-coaxial group (23.2 %, 77 out of 332) than the coaxial group (27 %, 86 out of 318). However, the difference in incidence between both groups was statistically insignificant (p = 0.14). Significant risk factors for the development of pneumothorax in both groups were emphysema (p < 0.001 in both groups), traversing a fissure with the biopsy needle (p value 0.005 in non-coaxial group and 0.001 in coaxial group), small lesion, less than 2 cm in diameter (p value of 0.02 in both groups), location of the lesion in the basal or mid sections of the lung (p = 0.003 and <0.001 in non-coaxial and coaxial groups, respectively), and increased needle track path within the lung tissue of more than 2.5 cm (p = 0.01 in both

  5. CT-guided vertebroplasty and kyphoplasty: comparing technical success rate and complications in 101 cases; CT-gesteuerte Vertebro- und Kyphoplastie: Vergleichende Untersuchung zu technischem Erfolg und Komplikationen bei 101 Eingriffen

    Energy Technology Data Exchange (ETDEWEB)

    Weber, C.H.; Kroetz, M.; Hoffmann, R.T.; Pfeifer, K.J.; Reiser, M.; Linsenmaier, U. [Inst. fuer Klinische Radiologie, LMU Muenchen (Germany); Euler, E.; Heining, S. [Chirurgische Klinik und Poliklinik, LMU Muenchen (Germany)

    2006-06-15

    Purpose: to compare the technical success and complication rates in CT-guided vertebroplasty and kyphoplasty. Materials and methods: from 2002 - 2005 69 patients (101 vertebrae) were treated with vertebroplasty (n = 82) or kyphoplasty (n = 19) using 4-slice MSCT with CT fluoroscopy as the sole guidance for the procedure. The underlying lesions were osteoporotic fractures in 78 vertebral bodies and 23 vertebral metastases. Results: technical success was achieved in all 101 procedures. Post-interventional CT demonstrated asymptomatic cement leakage in 51/101 vertebrae. Kyphoplasty resulted in leakage in 11/19 (57.9%) and vertebroplasty in 40/82 (48.8%) procedures. With p = 0.48 (Mann-Whitney test) there was no significant difference between kyphoplasty and vertebroplasty with respect to the number of cement leakage occurrences. There was one minor complication of an L5 root irritation following radiofrequency ablation and vertebroplasty of a sarcoma metastasis which subsided without treatment after 8 weeks. There was one major complication of intraspinal cement leakage during tumor vertebroplasty causing T5 root compression and requiring laminectomy for cement removal. The overall rate of major complications requiring treatment was 0.99%. (orig.)

  6. The Feasibility of Using CT-Guided ROI for Semiquantifying Striatal Dopamine Transporter Availability in a Hybrid SPECT/CT System

    Directory of Open Access Journals (Sweden)

    Chien-Chin Hsu

    2014-01-01

    Full Text Available A hybrid SPECT/CT system provides accurate coregistration of functional and morphological images. CT-guided region of interest (ROI for semiquantifying striatal dopamine transporter (DAT availability may be a feasible method. We therefore assessed the intra- and interobserver reproducibility of manual SPECT and CT-guided ROI methods and compared their semiquantitative data with data from MRI-guided ROIs. We enrolled twenty-eight patients who underwent Tc-99m TRODAT-1 brain SPECT/CT and brain MRI. ROIs of the striatal, caudate, putamen, and occipital cortex were manually delineated on the SPECT, CT, and MRI. ROIs from CT and MRI were transferred to the coregistered SPECT for semiquantification. The striatal, caudate, and putamen nondisplaceable binding potential (BPND were calculated. Using CT-guided ROIs had higher intra- and interobserver concordance correlation coefficients, closer Bland-Altman biases to zero, and narrower limits of agreement than using manual SPECT ROIs. The correlation coefficients of striatal, caudate, and putamen BPND were good between manual SPECT and MRI-guided ROI methods and even better between CT-guided and MRI-guided ROI methods. Conclusively, CT-guided ROI delineation for semiquantifying striatal DAT availability in a hybrid SPECT/CT system is highly reproducible, and the semiquantitative data correlate well with data from MRI-guided ROIs.

  7. The feasibility of using CT-guided ROI for semiquantifying striatal dopamine transporter availability in a hybrid SPECT/CT system.

    Science.gov (United States)

    Hsu, Chien-Chin; Chang, Yen-Hsiang; Lin, Wei-Che; Tang, Shu-Wen; Wang, Pei-Wen; Huang, Yung-Cheng; Chiu, Nan-Tsing

    2014-01-01

    A hybrid SPECT/CT system provides accurate coregistration of functional and morphological images. CT-guided region of interest (ROI) for semiquantifying striatal dopamine transporter (DAT) availability may be a feasible method. We therefore assessed the intra- and interobserver reproducibility of manual SPECT and CT-guided ROI methods and compared their semiquantitative data with data from MRI-guided ROIs. We enrolled twenty-eight patients who underwent Tc-99m TRODAT-1 brain SPECT/CT and brain MRI. ROIs of the striatal, caudate, putamen, and occipital cortex were manually delineated on the SPECT, CT, and MRI. ROIs from CT and MRI were transferred to the coregistered SPECT for semiquantification. The striatal, caudate, and putamen nondisplaceable binding potential (BPND) were calculated. Using CT-guided ROIs had higher intra- and interobserver concordance correlation coefficients, closer Bland-Altman biases to zero, and narrower limits of agreement than using manual SPECT ROIs. The correlation coefficients of striatal, caudate, and putamen BPND were good between manual SPECT and MRI-guided ROI methods and even better between CT-guided and MRI-guided ROI methods. Conclusively, CT-guided ROI delineation for semiquantifying striatal DAT availability in a hybrid SPECT/CT system is highly reproducible, and the semiquantitative data correlate well with data from MRI-guided ROIs.

  8. Diagnostic efficiency and complication rate of CT-guided lung biopsy: a single center experience of the procedures conducted over a 10-year period

    Institute of Scientific and Technical Information of China (English)

    YUAN Dong-mei; SONG Yong; L(U) Yan-ling; YAO Yan-wen; LIU Hong-bing; WANG Qian; XIAO Xin-wu; CAO E-hong; SHI Yi; ZHOU Xiao-jun

    2011-01-01

    Background Computed tomography (CT)-guided transthoracic lung biopsy is a well-established technique for the diagnosis of pulmonary lesions.The objective of this study was to evaluate the diagnostic efficiency and complication rate of CT-guided lung biopsy in a Chinese population.Methods CT-guided cutting needle lung biopsies were performed in our institution on 1014 patients between January 2000 and October 2010.A chest radiograph was taken after the biopsy.Data about basic patient information,final diagnosis,and complications secondary to biopsy procedure (pneumothorax and bleeding) were extracted.Results The diagnostic efficiency of CT-guided lung biopsy was 94.8%; only 53 patients did not get a final diagnosis from lung biopsy.Final diagnoses found 639 malignant lesions (63.0%) and 322 benign lesions (31.8%).Pneumothoraxoccurred in 131 patients and 15 required insertion of an intercostal drain.Small hemoptysis occurred in 41 patients and mild parenchymal hemorrhage occurred in 16 patients.The overall complication rate was 18.5%.Conclusions CT-guided cutting needle biopsy of pulmonary lesions is a relatively safe technique with a high diagnostic accuracy.It can be safely performed in clinical trials.

  9. Clinical efficacy of CT-guided iodine-125 seed implantation therapy in patients with advanced pancreatic cancer

    Energy Technology Data Exchange (ETDEWEB)

    Zhongmin, Wang [Soochow University, School of Radiation Medicine and Public Health, Suzhou (China); Shanghai Ruijin Hospital Luwan Branch, Shanghai (China); Yu, Liu; Kemin, Chen [Shanghai Ruijin Hospital, Department of Radiology, Shanghai (China); Fenju, Liu [Soochow University, School of Radiation Medicine and Public Health, Suzhou (China); Suzhou Industrial Park, Suzhou (China); Gang, Huang [Shanghai Jiao Tong University, Nuclear Medicine, School of Medicine, Shanghai (China)

    2010-07-15

    To examine the clinical efficacy of CT-guided radioactive iodine-125 (125I) seeds implantation treatment in patients with unresectable pancreatic cancer. Thirty-one patients with inoperable pancreatic cancer were enrolled in this study. The 125I seeds were implanted into pancreatic tumor under CT guidance. In addition, 10 patients received routine gemcitabine and 5-fluorouracil chemotherapy 1 week after brachytherapy. Median diameter of the tumor was 5.8 cm. Follow-up period was 2 to 25 months. Symptoms of refractory pain were significantly resolved post-interventionally (P < 0.05), and Karnofsky physical score increased dramatically (P < 0.05). Tumor response which was demonstrated on repeated CT film 2 months post-treatment revealed complete response (CR) in 3 cases, partial response (PR) in 16 cases, stable disease (SD) in 9 cases, and progressive disease (PD) in 3 cases. Overall responding rate (CR+PR) was 61.3%. Median survival time for all patients was 10.31 months. Two seeds of radioactive 125I migrated to the liver in 2 patients. There were no serious complications detected during the follow-up period. This study suggests that CT-guided brachytherapy using 125I seeds implantation appears to be safe, effective, uncomplicated, and could produce adequate pain relief for treating unresectable pancreatic cancer. (orig.)

  10. Evaluation of the effectiveness of CT-guided infiltration in the treatment of Arnold's neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Aubry, Sebastien [CHU Sherbrooke, Departement de Radiologie, Sherbrooke, QC (Canada); Universite de Franche-Comte, Laboratoire Intervention, Imagerie, Ingenierie et Innovation en Sante, Besancon (France); Kastler, Bruno [Universite de Franche-Comte, Laboratoire Intervention, Imagerie, Ingenierie et Innovation en Sante, Besancon (France); CHU Jean Minjoz, Service de Radiologie A, Besancon (France); Bier, Vincent; Hussein, Hussein Haj [CHU Jean Minjoz, Service de Radiologie A, Besancon (France); Hadjidekov, Vassil [Alexandrovska Hospital, Radiology Department, Sofia (Bulgaria); Fergane, Bernard [CHU Jean Minjoz, Centre d' Evaluation et de Traitement de la Douleur, Besancon (France)

    2009-03-15

    The aim of this study was to evaluate the effectiveness of computed tomography (CT)-guided infiltration in the treatment of Arnold's neuralgia. A retrospective study included 31 patients suffering from Arnold's neuralgia and having undergone a total of 45 CT-guided infiltrations of the greater occipital nerve (GON), in a proximal site (emergence of the GON, technique 1, n = 24) or in two proximal sites (emergence of the GON and at the site of the first bend of the GON drawn by the GON, technique 2, n = 21). Infiltration was considered to be effective when pain relief was equal to or greater than 50% for at least 1 month. There was no significant difference between the two techniques regarding immediate pain relief effect (53.3% for technique 1 vs. 60.5% for technique 2, p = 0.5), but technique 2 yielded better persistence of pain relief effect (p = 0.01), leading to a significantly higher percentage of effective infiltrations with technique 2 (p = 0.03). Infiltrations carried out in a single site yield results that are comparable to those previously published. Infiltrations in two sites provide significantly better results and should now be preferred to other single-site techniques in order to reduce the rate of failure or recurrence of Arnold's neuralgia. (orig.)

  11. 经皮经肝双极射频消融导管恶性梗阻性黄疸20例%Percutaneous transhepatic bipolar radiofrequency catheter ablation for the treatment of malignant obstructive jaundice:preliminary experience in 20 c ases

    Institute of Scientific and Technical Information of China (English)

    崔宁; 李晓群

    2014-01-01

    目的:探讨经皮经肝双极射频消融(RFA)导管治疗恶性梗阻性黄疸的可行性、安全性及初步疗效。方法选取20例失去手术治疗机会的恶性胆道梗阻患者(其中2例胆道支架再堵塞),采用经皮经肝穿刺胆道路径双极RFA治疗,消融功率为5~12 W,单次消融时间为60~120 s,消融持续时间平均4.66 min(1.5~8.5 min),有效消融范围平均为5.76 cm(4~10 cm)。消融后导入球囊扩张阻塞段,再植入胆道金属支架,观察术后疗效、安全性及并发症。结果20例患者均成功完成RFA治疗:17例植入胆道支架,其中11例支架植入前用球囊扩张;1例单行球囊扩张术未放置支架;2例胆道支架再阻塞后消融(1例球囊扩张)。术后未出现胆漏、胆道感染、肝贯通伤、腹膜炎等并发症。20例胆道引流均获成功;中位随访期为3个月(0.5~10个月);术后1、3个月分别有19例和14例支架通畅,术后1、3个月分别有19例和14例生存,随访期内,20例患者中8例生存,12例死亡。中位生存期为144 d(13~330 d),支架通畅中位时间为90 d(13~210 d)。12例死亡患者中8例因恶病质、多脏器功能衰竭死亡,但随访期内总胆红素等指标无升高。结论经皮肝穿刺胆道内导管射频消融术作为一种新型安全、可行的治疗方法,取得了一定疗效,但远期疗效仍有待进一步探讨。%Objective To investigate the feasibility, safety and clinical effect of percutaneous transhepatic bipolar radiofrequency catheter ablation in treating malignant obstructive jaundice. Methods Twenty patients with inoperable malignant biliary obstruction were enrolled in this study. Of the 20 cases , 2 had biliary stent re-occlusion. Percutaneous transhepatic bipolar radiofrequency catheter ablation was carried out in all patients. The ablation power was 5 - 12 W, single ablation time was 60 - 120 s, the average

  12. Transretroperitoneal CT-guided Embolization of Growing Internal Iliac Artery Aneurysm after Repair of Abdominal Aortic Aneurysm: A Transretroperitoneal Approach with Intramuscular Lidocaine Injection Technique

    Energy Technology Data Exchange (ETDEWEB)

    Park, Joon Young, E-mail: pjy1331@hanmail.net; Kim, Shin Jung, E-mail: witdd2@hanmail.net; Kim, Hyoung Ook, E-mail: chaos821209@hanmail.net [Chonnam National University Hospital, Department of Radiology (Korea, Republic of); Kim, Yong Tae, E-mail: mono-111@hanmail.net [Chonnam National University Hwasun Hospital, Department of Radiology (Korea, Republic of); Lim, Nam Yeol, E-mail: apleseed@hanmail.net; Kim, Jae Kyu, E-mail: kjkrad@jnu.ac.kr [Chonnam National University Hospital, Department of Radiology (Korea, Republic of); Chung, Sang Young, E-mail: sycpvts@jnu.ac.kr; Choi, Soo Jin Na, E-mail: choisjn@jnu.ac.kr; Lee, Ho Kyun, E-mail: mhaha@hanmail.net [Chonnam National University Hospital, Department of Surgery (Korea, Republic of)

    2015-02-15

    This study was designed to evaluate the efficacy and safety of CT-guided embolization of internal iliac artery aneurysm (IIAA) after repair of abdominal aortic aneurysm by transretroperitoneal approach using the lidocaine injection technique to iliacus muscle, making window for safe needle path for three patients for whom CT-guided embolization of IIAA was performed by transretroperitoneal approach with intramuscular lidocaine injection technique. Transretroperitoneal access to the IIAA was successful in all three patients. In all three patients, the IIAA was first embolized using microcoils. The aneurysmal sac was then embolized with glue and coils without complication. With a mean follow-up of 7 months, the volume of the IIAAs remained stable without residual endoleaks. Transretroperitoneal CT-guided embolization of IIAA using intramuscular lidocaine injection technique is effective, safe, and results in good outcome.

  13. Transretroperitoneal CT-guided embolization of growing internal iliac artery aneurysm after repair of abdominal aortic aneurysm: a transretroperitoneal approach with intramuscular lidocaine injection technique.

    Science.gov (United States)

    Park, Joon Young; Kim, Shin Jung; Kim, Hyoung Ook; Kim, Yong Tae; Lim, Nam Yeol; Kim, Jae Kyu; Chung, Sang Young; Choi, Soo Jin Na; Lee, Ho Kyun

    2015-02-01

    This study was designed to evaluate the efficacy and safety of CT-guided embolization of internal iliac artery aneurysm (IIAA) after repair of abdominal aortic aneurysm by transretroperitoneal approach using the lidocaine injection technique to iliacus muscle, making window for safe needle path for three patients for whom CT-guided embolization of IIAA was performed by transretroperitoneal approach with intramuscular lidocaine injection technique. Transretroperitoneal access to the IIAA was successful in all three patients. In all three patients, the IIAA was first embolized using microcoils. The aneurysmal sac was then embolized with glue and coils without complication. With a mean follow-up of 7 months, the volume of the IIAAs remained stable without residual endoleaks. Transretroperitoneal CT-guided embolization of IIAA using intramuscular lidocaine injection technique is effective, safe, and results in good outcome.

  14. 经皮经肝双极射频导管处理恶性胆道梗阻及胆道内支架再堵塞的初步临床观察%Preliminary clinical study of percutaneous transhepatic bipolar radiofrequency ablation catheter in the treatment for malignant biliary obstructive jaundice and biliary stent re-stenosis

    Institute of Scientific and Technical Information of China (English)

    席玮; 陈骏; 武贝; 陈世晞

    2013-01-01

    Objective To preliminary observe the feasibility and safety of bipolar radiofrequency ablation catheter in the treatment of malignant biliary obstructive jaundice and biliary stent re-stenosis.Methods Four patients with malignant obstructive jaundice caused by terminal cancer received ablation therapy for biliary obstruction by percutaneous transhepatic bipolar radiofrequency ablation catheter.The normal tunnel of biliary was reconstructed rapidly to restore the outflow tract of bile.The procedural practicality,clinical safety and operative complications were analyzed.Results The ablation therapy was successful for 4 patients.The mean operating duration was 40 min without any 30-day mortality.No postoperative complications such as massive hemorrhage,biliary fistula,biliary infection,hemothorax,pneumothorax,cholothorax,chole-heart syndrome,liver penetrating wound and biliary peritonitis etc.occurred.Cholangiectasis improved markedly after biliary tract reconstruction with general declines of serum total bilirubin and direct bilirubin.One case with biliary stent re-stenosis was re-blocked postoperatively.The average patency time of biliary tract and stent was 124 (90-171) days in 4 cases.Conditions were created for further anti-tumor treatment.Conclusion Percutaneous transhepatic bipolar radiofrequency ablation catheter can reestablish the canal rapidly for malignant biliary obstructive jaundice and stent restenosis so as to enhance the therapeutic efficacy.%目的 初步观察双极射频导管治疗恶性胆道梗阻及胆管内支架再堵塞的可行性和安全性.方法 江苏省肿瘤医院介入科2012年3至6月收治4例晚期肿瘤导致的恶性阻塞性黄疸患者,经皮经肝路径在胆管梗阻段使用经皮穿刺式双极射频导管消融治疗,功率6~8W,使用时间60-120 s,迅速重建通道,恢复胆汁流出路径,进行手术实用性、安全性评价及并发症观察.结果 4例患者消融手术顺利,平均手术时间40 min,30 d

  15. Percutaneous Procedures for the Treatment of Trigeminal Neuralgia.

    Science.gov (United States)

    Bender, Matthew T; Bettegowda, Chetan

    2016-07-01

    Three major percutaneous procedures are currently used to treat trigeminal neuralgia (TN). Percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation interrupt afferent pain fibers by injury to the trigeminal nerve root or ganglion. Each is capable of offering immediate and durable pain relief. Each is associated with relatively low, but variable rates of complications. Patient heterogeneity, technical variation, and nonstandard outcomes plague the existing outcomes literature and limit comparisons of treatments. Rendering treatment selection a function of individual physician preference and practice patterns. Randomized, prospective trials are needed; in the meantime, percutaneous rhizotomy remains an excellent treatment for selected patients.

  16. Short-term outcomes and safety of computed tomography-guided percutaneous microwave ablation of solitary adrenal metastasis from lung cancer: A multi-center retrospective study

    Energy Technology Data Exchange (ETDEWEB)

    Men, Min; Ye, Xin; Yang, Xia; Zheng, Aimin; Huang, Guang Hui; Wei, Zhigang [Dept. of Oncology, Shandong Provincial Hospital Affiliated with Shandong University, Jinan (China); Fan, Wei Jun [Imaging and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou (China); Zhang, Kaixian [Dept. of Oncology, Teng Zhou Central People' s Hospital Affiliated with Jining Medical College, Tengzhou (China); Bi, Jing Wang [Dept. of Oncology, Jinan Military General Hospital of Chinese People' s Liberation Army, Jinan (China)

    2016-11-15

    To retrospectively evaluate the short-term outcomes and safety of computed tomography (CT)-guided percutaneous microwave ablation (MWA) of solitary adrenal metastasis from lung cancer. From May 2010 to April 2014, 31 patients with unilateral adrenal metastasis from lung cancer who were treated with CT-guided percutaneous MWA were enrolled. This study was conducted with approval from local Institutional Review Board. Clinical outcomes and complications of MWA were assessed. Their tumors ranged from 1.5 to 5.4 cm in diameter. After a median follow-up period of 11.1 months, primary efficacy rate was 90.3% (28/31). Local tumor progression was detected in 7 (22.6%) of 31 cases. Their median overall survival time was 12 months. The 1-year overall survival rate was 44.3%. Median local tumor progression-free survival time was 9 months. Local tumor progression-free survival rate was 77.4%. Of 36 MWA sessions, two (5.6%) had major complications (hypertensive crisis). CT-guided percutaneous MWA may be fairly safe and effective for treating solitary adrenal metastasis from lung cancer.

  17. Short-Term Outcomes and Safety of Computed Tomography-Guided Percutaneous Microwave Ablation of Solitary Adrenal Metastasis from Lung Cancer: A Multi-Center Retrospective Study

    Science.gov (United States)

    Men, Min; Fan, Weijun; Zhang, Kaixian; Bi, Jingwang; Yang, Xia; Zheng, Aimin; Huang, Guanghui; Wei, Zhigang

    2016-01-01

    Objective To retrospectively evaluate the short-term outcomes and safety of computed tomography (CT)-guided percutaneous microwave ablation (MWA) of solitary adrenal metastasis from lung cancer. Materials and Methods From May 2010 to April 2014, 31 patients with unilateral adrenal metastasis from lung cancer who were treated with CT-guided percutaneous MWA were enrolled. This study was conducted with approval from local Institutional Review Board. Clinical outcomes and complications of MWA were assessed. Results Their tumors ranged from 1.5 to 5.4 cm in diameter. After a median follow-up period of 11.1 months, primary efficacy rate was 90.3% (28/31). Local tumor progression was detected in 7 (22.6%) of 31 cases. Their median overall survival time was 12 months. The 1-year overall survival rate was 44.3%. Median local tumor progression-free survival time was 9 months. Local tumor progression-free survival rate was 77.4%. Of 36 MWA sessions, two (5.6%) had major complications (hypertensive crisis). Conclusion CT-guided percutaneous MWA may be fairly safe and effective for treating solitary adrenal metastasis from lung cancer. PMID:27833402

  18. CT guided biopsies as a part of the investigations in findings in the lung and thorax wall

    DEFF Research Database (Denmark)

    Vagn-Hansen, Chris Aksel; Pedersen, Malene Roland Vils; Rafaelsen, Søren Rafael

    was performed. Results: In 86 % of the biopsies, the tissue material was found sufficient. In 32 % of the biopsies there was a complication, mostly pneumothorax (30%), but in only 15 % of the 520 cases chest drainage was needed. There was one death in a known cancer patient with severe reduced lung and cardiac...... function. Patients with more than 10 cigarette pack years had a complication risk twice as high compared to patients with less pack years. We found that the risk of pneumothorax rises the further the lesion is from the skin surface, the smaller the lesions are and when the patient is biopsied in a lateral...... position. We found a higher risk of complications in females. Conclusion: CT guided biopsy is an excellent tool in the analysis of lesions in the lungs. This study clearly shows that the risk of developing a pneumothorax is significantly higher among smokers and former smokers with more than 10 pack years....

  19. PET/CT-guided treatment planning for paediatric cancer patients: a simulation study of proton and conventional photon therapy

    DEFF Research Database (Denmark)

    Kornerup, Josefine S.; Brodin, N. P.; Bjork-Eriksson, T.;

    2015-01-01

    OBJECTIVE: To investigate the impact of including fluorine-18 fludeoxyglucose ((18)F-FDG) positron emission tomography (PET) scanning in the planning of paediatric radiotherapy (RT). METHODS: Target volumes were first delineated without and subsequently re-delineated with access to (18)F-FDG PET......) and estimated risk of secondary cancer (SC). RESULTS: Considerable deviations between CT- and PET/CT-guided target volumes were seen in 3 out of the 11 patients studied. However, averaging over the whole cohort, CT or PET/CT guidance introduced no significant difference in the shape or size of the target...... volumes, target dose coverage, irradiated volumes, estimated NTCP or SC risk, neither for IMPT nor 3DCRT. CONCLUSION: Our results imply that the inclusion of PET/CT scans in the RT planning process could have considerable impact for individual patients. There were no general trends of increasing...

  20. CT guided aspiration biopsy of thoracic tumors clinical analysis of 30 cases%CT导引下胸内肿物穿刺活检30例临床分析

    Institute of Scientific and Technical Information of China (English)

    邓磊

    2012-01-01

      Objective Discussion and analysis of CT guided puncture biopsy of thoracic masses in the safety and diagnostic value. Methods In 2005 June to 2009 June outpatient or inpatient by X-ray or CT revealed 30 patients with intrathoracic masses as the research object, its are to be under the guidance of CT intrathoracic tumor biopsy, retrospective analysis. Results 30 cases were successful, including 27 cases of tumor, the tumor in 3 cases, biopsy diagnosis rate was 96.7%. Biopsy of 4 cases had complications, which accounted for 13.3%, a small number of pneumothorax in 2 cases, appearance of blood in the sputum of 2 cases, all recovered after conservative treatment. Conclusion CT guided thoracic mass percutaneous needle biopsy is a safe and effective diagnostic method, is worth the clinical promoted application.%  目的分析探讨CT导引下胸内肿物穿刺活检的安全性与诊断价值.方法选择2005年6月-2009年6月门诊或住院经X线或CT检查显示胸内肿块的30例患者为研究对象,对其均予以CT导引下胸内肿物穿刺活检,回顾性分析其临床资料.结果30例患者均穿刺成功,其中肿瘤27例,非肿瘤3例,活检诊断率为96.7%.穿刺活检中共发生并发症4例,占13.3%,其中出现少量气胸2例,出现痰中带血2例,经保守治疗后均痊愈.结论 CT导引下胸内肿物穿刺活检是一种安全有效的诊断方法,值得临床推广运用.

  1. Application of Intraoperative CT-Guided Navigation in Simultaneous Minimally Invasive Anterior and Posterior Surgery for Infectious Spondylitis

    Directory of Open Access Journals (Sweden)

    Meng-Huang Wu

    2017-01-01

    Full Text Available This study was aimed at evaluating the safety and efficacy of using intraoperative computed tomography- (iCT- guided navigation in simultaneous minimally invasive anterior and posterior surgery for infectious spondylitis. Nine patients with infectious spondylitis were enrolled in this study. The average operative time was 327.6 min (range, 210–490 and intraoperative blood loss was 407 cc (range, 50–1,200. The average duration of hospital stay was 48.9 days (range, 11–76. Out of a total of 54 pedicle screws employed, 53 screws (98.1% were placed accurately. A reduced visual analog scale on back pain (from 8.2 to 2.2 and Oswestry disability index (from 67.1% to 25.6% were found at the 2-year follow-up. All patients had achieved resolution of spinal infection with reduced average erythrocyte sedimentation rate (from 83.9 to 14.1 mm/hr and average C-reactive protein (from 54.4 to 4.8 mg/dL. Average kyphotic angle correction was 10.5° (range, 8.4°–12.6° postoperatively and 8.5° (range, 6.9°–10.1° after 2 years. In conclusion, the current iCT-guided navigation approach has been demonstrated to be an alternative method during simultaneous minimally invasive anterior and posterior surgery for infectious spondylitis. It can provide a good intraoperative orientation and visualization of anatomic structures and also a high pedicle screw placement accuracy in patient’s lateral decubitus position.

  2. Application of Intraoperative CT-Guided Navigation in Simultaneous Minimally Invasive Anterior and Posterior Surgery for Infectious Spondylitis

    Science.gov (United States)

    Dubey, Navneet Kumar; Lee, Ching-Yu; Li, Yen-Yao; Cheng, Chin-Chang; Shi, Chung-Sheng

    2017-01-01

    This study was aimed at evaluating the safety and efficacy of using intraoperative computed tomography- (iCT-) guided navigation in simultaneous minimally invasive anterior and posterior surgery for infectious spondylitis. Nine patients with infectious spondylitis were enrolled in this study. The average operative time was 327.6 min (range, 210–490) and intraoperative blood loss was 407 cc (range, 50–1,200). The average duration of hospital stay was 48.9 days (range, 11–76). Out of a total of 54 pedicle screws employed, 53 screws (98.1%) were placed accurately. A reduced visual analog scale on back pain (from 8.2 to 2.2) and Oswestry disability index (from 67.1% to 25.6%) were found at the 2-year follow-up. All patients had achieved resolution of spinal infection with reduced average erythrocyte sedimentation rate (from 83.9 to 14.1 mm/hr) and average C-reactive protein (from 54.4 to 4.8 mg/dL). Average kyphotic angle correction was 10.5° (range, 8.4°–12.6°) postoperatively and 8.5° (range, 6.9°–10.1°) after 2 years. In conclusion, the current iCT-guided navigation approach has been demonstrated to be an alternative method during simultaneous minimally invasive anterior and posterior surgery for infectious spondylitis. It can provide a good intraoperative orientation and visualization of anatomic structures and also a high pedicle screw placement accuracy in patient's lateral decubitus position.

  3. Hemorrhagic Cardiac Tamponade: Rare Complication of Radiofrequency Ablation of Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Loh, Kok Beng; Bux, Shaik Ismail; Abdullah, Basri Johan Jeet; Mokhtar, Raja Amin Raja; Mohamed, Rosmawati [Faculty of Medicine, University of Malaya, Kuala Lumpur (Malaysia)

    2012-09-15

    Local treatment for hepatocellular carcinoma (HCC) has been widely used in clinical practice due to its minimal invasiveness and high rate of cure. Percutaneous radiofrequency ablation (RFA) is widely used because its treatment effectiveness. However, some serious complications can arise from percutaneous RFA. We present here a rare case of hemorrhagic cardiac tamponade secondary to an anterior cardiac vein (right marginal vein) injury during RFA for treatment of HCC.

  4. Use of CT-guided fine needle aspiration biopsy in epidermal growth factor receptor mutation analysis in patients with advanced lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Zhuang, Yi-Ping; Wang, Hai-Yan; Zhang, Jin; Feng, Yong (Dept. of Radiology, Jiangsu Cancer Inst. and Hospital, Nanjing, Jiangsu (China)), email: yipingzhuang2010@sina.com; Shi, Mei-Qi (Dept. of Chemotherapy, Jiangsu Cancer Inst. and Hospital, Nanjing, Jiangsu (China))

    2011-12-15

    Background. The safety of using a cutting needle when performing a core-needle biopsy is of major concern, in particular for small lung tumors or tumors near the hilum. Purpose. To investigate the usefulness of CT-guided fine needle aspiration biopsy (FNAB) of the lung in obtaining tumor tissue for epidermal growth factor receptor (EGFR) mutation analysis in advanced lung cancer patients. Material and Methods. Forty-three patients with stage IIIB-IV lung cancer were enrolled. In all patients, CT-guided FNAB was performed using an 18-gauge or 20-gauge Chiba aspiration needle for histology diagnosis and EGFR mutation analysis. Complications associated with CT-guided FNAB were observed, and the specimen mutational assessments were recorded. Results. The obtained tumor samples ranged from 0.5-1.5 cm in length and were adequate for histological and DNA analyses in all patients. No patient had a pneumothorax or hemoptysis. Minor needle tract bleeding appeared in eight patients. Mutation analysis was satisfactorily demonstrated in 23 mutations and 20 non-mutations. Ten and 13 mutations were identified by 18-gauge and 20-gauge needle biopsies, respectively. EFGR mutations, including 12 cases of EGFR exon 19 deletion and 11 cases of exon 21 point mutation, were present in 21 patients with adenocarcinomas, one with squamous cell carcinoma, and one with undifferentiated carcinoma. Conclusion. CT-guided FNAB is a feasible and safe technique for obtaining lung tumor tissues for EGFR gene mutation analysis

  5. CT引导射频消融治疗结直肠癌肝转移的应用价值%Application value of CT-guided radiofreguency ablation on metastatic liver carciaoma caused by colorectal cancer

    Institute of Scientific and Technical Information of China (English)

    李德周; 赵玉东; 赵玉鑫

    2014-01-01

    Objective To investigate the indications,therapeutic regimen and effects of CT-guided radio frequency ablation(RFA) in the treatment of metastatic liver carciaoma caused by colorectal cancer.Methods Fifty-six patients(124 lesions)clinically and pathologically diagnosed with metastatic liver carciaoma caused by colorectal cancer scheduled for RFA were included into this study.The average diameter of the tumors was (3.5 ± 1.4)cm,tumors with diameter≥4 cm accounting for 32.3% (40/124 leisions),single tumor accounting for 32.1% (18 leisions).All patients were examined by contrasted enhanced CT examination,the indications of RFA were made according to leision numbers,size,shape,infiltration range,location and relations with the surrounding structures.All the 56 patients were treated by conventional CT-guided percutanous RFA.The effects were evaluated by contrasted enhanced CT examination during the 1 to 4 months follow-up.Results According to the results of contrasted enhanced CT examination,56 patients (124 lesions) were given RFA staging treatment and expanding ablationtreatment.Tumor deactivation rate was 93.5% (116/124 lesions),local recurrence rate was 8.0% (10/124 lesions),and new metastasis rate was 39.3% (20/56 cases).Conclusions CT-guided radio frequency ablation is an important supplementary method for the treatment of metastatic liver carciaoma caused by colorectal cancer,enhanced CT examination can provide reference for indications selection and treatment scheme made of metastatic liver carciaoma.%目的 探讨CT引导下射频消融(RFA)治疗结直肠癌肝转移的适应证、治疗方案及疗效.方法 选择56例(124个病灶)经临床及病理确诊为结直肠癌肝转移并拟行RFA者纳入本研究.肿瘤平均直径为(3.5±1.4)cm,直径≥4 cm肿瘤占32.3%(40/124病灶),单发肿瘤占32.1%(18例).所有患者均行增强CT检查,根据病灶数目、大小、形态、浸润范围、位置、与周围结构关

  6. 肝动脉化疗栓塞与射频不同联合方案对不能切除肝癌的疗效比较%EFFECT OF THE DIFFERENTLY COMBINED TREATMENTS OF TRANSCATHETER ARTERIAL CHEMOEMBOLIZATION AND PERCUTANEOUS RADIO-FREQUENCY ABLATION ON PATIENTS WITH UNRESCTABLE HEPATOCELLULAR CARCINOMA

    Institute of Scientific and Technical Information of China (English)

    宋斌; 王卫星; 董瑞; 张文

    2003-01-01

    目的:探讨射频消融(RF)术前行肝动脉化疗栓塞(TACE)与RF术后行TACE两种联合治疗方案对肝癌的疗效.方法:将接受TACE与RF联合治疗的61例不可切除性肝癌患者分为两组.一组为TACE+RF组,32例;另一组为RF+TACE组,29例.分别将两组治疗后肿瘤缩小率、消融率、瘤周血流信号、AFP值及治疗后6个月、12个生存率进行对比.结果:两组五种指标均具有显著性差异,TACE+RF组优于RF+TACE组.结论:对于中晚期不可切除性肝癌患者提倡采用TACE+RF联合治疗方案,即RF术前先行TACE,以增强两治疗方法之间互补性与疗效.%Objective:To evaluate the effect of the differently combined therapy methods of transcatheter arterial chemoembolization (TACE) and percutaneous radio-frequency ablation (RF) on patients with unresectable hepatocellular carcinoma (HCC).Methods:32 unresectable HCC patients (group TACE+RF) received the combined therapy of TACE before RF. 29 unresectable HCC patients received the combined therapy of TACE after RF. The datas of color-ultrasonography, AFP, 6-months and 12-months survival rate of two groups were compared.Results:There were remarkable difference in these datas of two groups.Conclusions:The combined method of performed TACE before RF is more effective in treating the unresectable hepatocellular carcinoma.

  7. Sacral-neuromodulation CT-guided; Nuova tecnica di centraggio TC-assistista nella neuromodulazione sacrale

    Energy Technology Data Exchange (ETDEWEB)

    Amoroso, Lamberto; Ricci, Stefano [INRCA, Ancona (Italy). Dipartimento di radiologia e medicina nucleare; Pelliccioni, Giuseppe; Scarpino, Osvaldo [INRCA, Ancona (Italy). Unita' operativa di radiologia; Ghiselli, Roberto; Saba, Vittorio [INRCA, Ancona (Italy). Dipartimento di chirurgia

    2005-04-01

    Purpose: Sacral neuromodulation is a new treatment for refractory voiding disorders such as urge incontinence, urinary retention, frequency-urgency syndromes and faecal incontinence. The current approach to sacral nerve stimulation consists of a two-stage procedure. The first is a PNE test (Percutaneous Nerve Evaluation) by a provisional electrically stimulated spinal needle, placed percutaneously in the S3 foramina for four of ten days. If successful, the second stage, permanent implantation, is carried out. The PNE test is performed under fluoroscopic control using the palpable bony sacral foramina as referral points. This technique can show some limitations, such as operator Rx exposure, poor visualization of sacral foramina because of bowel gas artefacts or sacral malformation. In order to reduce these inconveniences and to improve efficiency of the test we tried an alternative technique. The purpose of our study was to test the use of CT as an alternative technique in order to evaluate its advantages and possible routine use. Materials and methods: We tested 30 patients with the PNE test under CT guidance (16 males and 14 females) suffering from serious pelvic disorders and not responding to the normal therapeutic regime. Twenty-seven patient showed relative anatomical integrity of the pelvis and the sacrum, the remaining 3 patients presented morphological anormalities of the sacral foramina. With the patient in the prone position the sacral foramina were identified with CT volumetric scanning using a spiral CT scanner equipped with a second console for the three-dimensional reconstructions. Having identified the location of the S3 foramina, a sterile field was prepared and the spiral needle introduced checking correct positioning with a CT control scan. An electrode was inserted after having checked correct muscular contractile response and the precise position with a further CT scan. Results: Thirty patients were subjected to PNE under CT guidance for a

  8. Methodology of percutaneous bi-polar radiofrequency ablation of thyroid adenomas under ultrasound guidance and monitoring%超声引导监测下经皮射频消融甲状腺腺瘤的方法学研究

    Institute of Scientific and Technical Information of China (English)

    章建全; 马娜; 徐斌; 刘灿; 宋家琳; 刁宗平

    2010-01-01

    Objective To establish a treatment proposal of thyroid adenoma by using percutaneous radiofrequency ablation(RFA) and investigate its techniques and skills, means and steps, and safety and efficacy. Methods Contrast-enhanced ultrasound-guided percutaneous RFA of thyroid adenomas were conducted on 202 patients by using an auto-controlled bi-polar electrode system. The indications of thyroid RFA,the optimal puncture route,the ways of anesthesia administration, protection of vital neck vessels and recurrent laryngeal nerve(RLN) and reduction of bleeding from core biopsy, indicators of ending ablation procedure following a complete ablation were investigated and analyzed. Resalts An adenoma smaller than 20 mm in maximal diameter was the optimal candidate for RFA. Either of two puncture routes could be selected upon the target lesion's location. Areas surrounding to the thyroid capsule needed adequate local anesthesia to kill pain. Liquid-isolating maneuver could effectively protect carotid artery and RLN from core needle cutting and electrode heating injury. Advanced block of supplying arteries with heating markedly reduced bleeding involved in the biopsy. Multipoint and multicenter ablation was essential to a complete coagulation. Filling-defect in the ablated adenoma on CEUS was the key sign to terminate ablation procedure. Conclusions Percutaneous bi-polar RFA was proved feasible, effective, safe and supermicroinvasive for treating thyroid adenoma under the way stated here of puncture and technical points and use of CEUS for monitoring.%目的 建立经皮射频消融治疗甲状腺腺瘤的方案,探讨其技术特征、方法步骤、安全性及疗效评价手段.方法 使用Celon-ProBreath双极式射频电极针在高频超声引导和超声造影监测下对甲状腺腺瘤进行经皮穿刺消融,就消融适应证、最佳穿刺路径、麻醉方式、保护重要血管和喉返神经、减少活检出血、判断消融彻底性以及终止消融的指征

  9. 超声引导经皮双极射频消融治疗甲状腺良性结节%Efficacy of ultrasound-guided percutaneous bipolar radiofrequency ablation of benign thyroid nodules

    Institute of Scientific and Technical Information of China (English)

    李小龙; 卢峰; 徐辉雄; 孙丽萍; 郭乐杭; 张一峰; 伯小皖; 曲伸

    2016-01-01

    目的 观察超声引导下经皮双极射频消融(radiofrequency ablation,RFA)治疗甲状腺良性结节的局部疗效.方法 选取在我院收治的33例患者,对所有患者采取超声引导下经皮双极射频消融治疗,分别于术前及术后1、3和6个月采用常规超声及超声造影观察结节的大小、血供及并发症发生情况,并于术前及术后第1个月查甲状腺功能指标,以评价局部疗效.结果 所有患者均成功施行一次RFA.术后即刻超声造影,显示33枚结节无增强,完全消融率为100%(33/33).所有患者术中及术后无明显并发症产生,3例术中声音嘶哑,术后恢复正常,为局麻药一过性反应;1例术后有轻微血肿,未作特殊处理1周后超声复查血肿全部吸收.RFA术后6个月100%(33/33)结节体积较术前缩小超过50%,9.09%(3/33)结节体积较术前缩小超过90%.结论 双极RFA治疗甲状腺良性结节是一种有效和安全的方式,有良好的临床应用前景.

  10. Radiofrequency ablation in dermatology

    Directory of Open Access Journals (Sweden)

    Sachdeva Silonie

    2007-01-01

    Full Text Available Radiofreqeuency ablation is a versatile dermatosurgical procedure used for surgical management of skin lesions by using various forms of alternating current at an ultra high frequency. The major modalities in radiofrequency are electrosection, electrocoagulation, electrodessication and fulguration. The use of radiofrequency ablation in dermatosurgical practice has gained importance in recent years as it can be used to treat most of the skin lesions with ease in less time with clean surgical field due to adequate hemostasis and with minimal side effects and complications. This article focuses on the major tissue effects and factors influencing radiofrequency ablation and its application for various dermatological conditions.

  11. Radiation dose reduction in CT-guided sacroiliac joint injections to levels of pulsed fluoroscopy: a comparative study with technical considerations

    Directory of Open Access Journals (Sweden)

    Artner J

    2012-08-01

    Full Text Available Juraj Artner, Balkan Cakir, Heiko Reichel, Friederike LattigDepartment of Orthopaedic Surgery, University of Ulm, RKU, GermanyBackground: The sacroiliac (SI joint is frequently the primary source of low back pain. Over the past decades, a number of different SI injection techniques have been used in its diagnosis and therapy. Despite the concerns regarding exposure to radiation, image-guided injection techniques are the preferred method to achieve safe and precise intra-articular needle placement. The following study presents a comparison of radiation doses, calculated for fluoroscopy and CT-guided SI joint injections in standard and low-dose protocol and presents the technical possibility of CT-guidance with maximum radiation dose reduction to levels of fluoroscopic-guidance for a precise intra-articular injection technique.Objective: To evaluate the possibility of dose reduction in CT-guided sacroiliac joint injections to pulsed-fluoroscopy-guidance levels and to compare the doses of pulsed-fluoroscopy-, CT-guidance, and low-dose CT-guidance for intra-articular SI joint injections.Study design: Comparative study with technical considerations.Methods: A total of 30 CT-guided intra-articular SI joint injections were performed in January 2012 in a developed low-dose mode and the radiation doses were calculated. They were compared to 30 pulsed-fluoroscopy-guided SI joint injections, which were performed in the month before, and to five injections, performed in standard CT-guided biopsy mode for spinal interventions. The statistical significance was calculated with the SPSS software using the Mann–Whitney U-Test. Technical details and anatomical considerations were provided.Results: A significant dose reduction of average 94.01% was achieved using the low-dose protocol for CT-guided SI joint injections. The radiation dose could be approximated to pulsed-fluoroscopy-guidance levels.Conclusion: Radiation dose of CT-guided SI joint injections can be

  12. Radiofrequency ablation of pulmonary tumors

    Energy Technology Data Exchange (ETDEWEB)

    Crocetti, Laura, E-mail: l.crocetti@med.unipi.i [Division of Diagnostic Imaging and Intervention, Department of Liver Transplants, Hepatology and Infectious Diseases, Pisa University School of Medicine (Italy); Lencioni, Riccardo [Division of Diagnostic Imaging and Intervention, Department of Liver Transplants, Hepatology and Infectious Diseases, Pisa University School of Medicine (Italy)

    2010-07-15

    The development of image-guided percutaneous techniques for local tumor ablation has been one of the major advances in the treatment of solid tumors. Among these methods, radiofrequency (RF) ablation is currently established as the primary ablative modality at most institutions. RF ablation is accepted as the best therapeutic choice for patients with early-stage hepatocellular carcinoma when liver transplantation or surgical resection are not suitable options and is considered as a viable alternate to surgery for inoperable patients with limited hepatic metastatic disease, especially from colorectal cancer. Recently, RF ablation has been demonstrated to be a safe and valuable treatment option for patients with unresectable or medically inoperable lung malignancies. Resection should remain the standard therapy for non-small cell lung cancer (NSCLC) but RF ablation may be better than conventional external-beam radiation for the treatment of the high-risk individual with NSCLC. Initial favourable outcomes encourage combining radiotherapy and RF ablation, especially for treating larger tumors. In the setting of colorectal cancer lung metastases, survival rates provided by RF ablation in selected patients, are substantially higher than those obtained with any chemotherapy regimens and provide indirect evidence that RF ablation therapy improves survival in patients with limited lung metastatic disease.

  13. Application of C-arm CT-guided targeted puncturing technique in performing non-vascular interventional procedures%C臂CT引导经皮靶向穿刺术在非血管介入诊疗中的应用

    Institute of Scientific and Technical Information of China (English)

    何玉圣; 周春泽; 吕维富

    2014-01-01

    Objective To investigate the clinical value of C-arm CT-guided targeted puncturing technique in performing non-vascular interventional procedures.Methods DSA-guided percutaneous puncturing biopsy or interventional therapy was performed in 33 patients, and the clinical effect and complication were observed and analyzed.Results Percutaneous puncturing interventional therapy was performed successfully in 15 patients,and percutaneous puncturing biopsy was performed in 18 patients and pathological results were obtained in 17 pa-tients.Conclusion The percutaneous targeted puncturing technique with C-arm CT-guidance combines the advantages of both CT and X-ray,which can meet the need of accuracy,efficiency and safety in non-vascular interventional therapy.%目的:探讨C臂CT引导下靶向穿刺技术在非血管介入诊疗中的应用价值。方法33例患者在DSA引导下行经皮穿刺活检术或经皮穿刺介入治疗,观察分析临床效果、并发症等。结果经皮穿刺介入治疗15例,均取得成功,另外18例为经皮穿刺病理活检,17例取得明确病理结果。结论 C臂CT引导下靶向穿刺技术实现了CT和X线透视优势互补,达到精确、高效、安全的非血管介入诊疗要求,值得推广应用。

  14. Radiofrequency coblation tonsillectomy.

    Science.gov (United States)

    Grobler, Alethea; Carney, A Simon

    2006-06-01

    Radiofrequency coblation is a new technology that is finding favour as a method for performing tonsillectomy. Its benefits include reduced pain and postoperative morbidity but there is controversy regarding possible increased postoperative haemorrhage rates.

  15. CT-guided interstitial brachytherapy of hepatocellular carcinoma before liver transplantation: an equivalent alternative to transarterial chemoembolization?

    Energy Technology Data Exchange (ETDEWEB)

    Denecke, Timm; Stelter, Lars; Schnapauff, Dirk; Steffen, Ingo; Gebauer, Bernhard; Lopez Haenninen, Enrique; Wust, Peter [Universitaetsmedizin Berlin, Klinik fuer Radiologie, Charite, Berlin (Germany); Sinn, Bruno [Charite - Universitaetsmedizin Berlin, Institut fuer Pathologie, Berlin (Germany); Schott, Eckart [Charite 2 - Universitaetsmedizin Berlin, Medizinische Klinik m.S. Hepatologie und Gastroenterologie, Berlin (Germany); Seidensticker, Ricarda [Universitaetsklinikum der Otto-v.-Gericke-Universitaet, Klinik fuer Radiologie und Nuklearmedizin, Magdeburg (Germany); Puhl, Gero; Neuhaus, Peter; Seehofer, Daniel [Charite - Universitaetsmedizin Berlin, Klinik fuer Allgemein-, Viszeral- und Transplantationschirurgie, Berlin (Germany)

    2015-09-15

    Transarterial chemoembolization (TACE) is established as bridging therapy of HCC listed for transplantation (LT). CT-guided brachytherapy (CTB) has not been evaluated as a bridging concept. We compared CTB and TACE for bridging before LT in HCC patients. Twelve patients with HCC received LT after CTB (minimal tumour dose, 15-20 Gy). Patients were matched (CTB:TACE, 1:2) by sex, age, number and size of lesions, and underlying liver disease with patients who received TACE before transplantation. Study endpoints were extent of necrosis at histopathology and recurrence rate after OLT. There were no significant differences between the CTB and TACE groups regarding Child-Pugh category (p = 0.732), AFP (0.765), time on waiting list (p = 0.659), number (p = 0.698) and size (p = 0.853) of HCC lesions, fulfilment of Milan-criteria (p = 0.638), or previous liver-specific treatments. CTB achieved higher tumour necrosis rates than TACE (p = 0.018). The 1- and 3-year recurrence rate in the CTB group was 10 and 10 % vs. TACE, 14 and 30 % (p = 0.292). Our data show comparable or even better response and post-LT recurrence rates of CTB compared to TACE for treating HCC in patients prior to LT. CTB should be further evaluated as an alternative bridging modality, especially for patients not suited for TACE. (orig.)

  16. [CT-guided electrode placement for sacral nerve stimulation in the treatment of faecal incontinence (cSNS)].

    Science.gov (United States)

    Goos, M; Ruf, G; Jargon, D; Trummer, C; Thomusch, O; Grüneberger, J; Bulla, S; Kotter, E; Ruthmann, O

    2014-12-01

    The sacral nerve stimulation (SNS) can be performed in the screening phase under local anaesthesia. Implantation of the tined-lead electrodes is usually performed in an inpatient setting under general anaesthesia. An outpatient procedure for both PNE and implantation of the electrodes offers decisive advantages with respect to the accuracy of electrode placement. From 2006 to 2011 a total of 51 patients was treated with SNS in an outpatient setting. Of 51 patients having the PNE, in four patients the procedure could not successfully be completed. In 39 of the 47 patients screened, the testing was positive. Eight times the screening was negative. The functional results show a significant decline in the Cleveland scores from 14.9 to 6.4. The manometric resting pressure improved from 23.4 mmHg to 43.81 mmHg, the squeezing pressure improved from 42.2 mmHg to 76.12 mmHg. Due to patients' perception and according to the response on the stimulus, the electrodes were placed on the left in S4 11 times, 23 times in the left S3, 3 times in the right S3, once in the left S2 and once in the right S2. CT-guided electrode placement is safe for temporary (subchronic) and permanent (chronic) sacral nerve stimulation and provides a valuable means for placement of the stimulating material. Georg Thieme Verlag KG Stuttgart · New York.

  17. CT-guided cutting needle biopsy of lung lesions - Safety and efficacy of an out-patient service

    Energy Technology Data Exchange (ETDEWEB)

    Charig, M.J.; Phillips, A.J

    2000-12-01

    AIM: To determine the safety and efficacy of CT-guided cutting needle biopsy of lung lesions as an out-patient procedure. MATERIALS AND METHODS:A total of 185 consecutive biopsies were performed under CT guidance on 183 patients between January 1991 and December 1998 using 20-gauge (n= 33), 18-gauge (n= 151) or 14-gauge (n= 1) core biopsy needles. A chest radiograph was taken after observation in the Radiology department for 1 h and asymptomatic patients were discharged. RESULTS: The histology was malignant in 150 biopsies (81.1%) and benign in 23 (12.4%) with 12 false-negative results (6.5%); there were no false-positive results. The sensitivity was 92.6%; specificity 100%; negative predictive value 65.7%; and overall accuracy 93.5%. Pneumothoraces occurred in 48 patients (25.9%); one required aspiration only and four required insertion of an intercostal drain. One patient developed a pneumothorax after discharge. Small haemoptyses occurred in 13 patients without pneumothorax (7.0%), one of whom was admitted. In-patient treatment was required in 10 patients (5.4%). CONCLUSION: Computed tomography-guided cutting needle biopsy of pulmonary lesions is a safe technique with a diagnostic accuracy and complication rate comparable to reported figures for fine needle aspiration biopsy. It can be safely performed on an out-patient basis. Charig, M.J., Phillips, A.J. (2000)

  18. CT-guided thoracal sympathicolysis for the treatment of peripheral arterial occlusive disease and chronic thoracal pain syndromes in 6 patients; CT-gesteuerte thorakale Sympathikolyse zur Behandlung der peripheren arteriellen Verschlusskrankheit und thorakaler Schmerzen in 6 Faellen

    Energy Technology Data Exchange (ETDEWEB)

    Finkenzeller, T.; Techert, J.; Lenhart, M.; Link, J.; Feuerbach, S. [Klinikum der Univ. Regensburg (Germany). Abt. Roentgendiagnostik

    2001-10-01

    Purpose: Retrospective evaluation of the safety and effectivity of CT-guided percutaneous thoracal sympathicolysis (CT-TSL) in the treatment of patients with peripheral arterial occlusive disease (PAOD) of the upper limb and chronic thoracal pain syndromes. Comparison of our own experience with literature reports. Material and Methods: Between 6/96 and 12/99, 4 patients with PAOD of the upper limb and two with chronic thoracal pain syndromes caused by herpes zoster were treated by unilateral CT-TSL. Results: 18, 21 and 32 months after the intervention 3 out of 4 patients treated for PAOD reported subjective improvements, and one remained unchanged. Two patients treated for pain syndromes showed no long-term benefit of the procedure. There were no serious complications. Conclusion: The CT-TSL is an alternative method in the treatment of PAOD in patients who are unsuitable for treatment by revascularization. (orig.) [German] Ziel: Retrospektive Betrachtung der Sicherheit und Effektivitaet der CT-gesteuerten thorakalen Sympathikolyse (CT-TSL) bei der Behandlung von Patienten mit peripherer arterieller Verschlusskrankheit (AVK) der oberen Extremitaet oder chronischer thorakaler Schmerzsyndrome, und Vergleich der eigenen Erfahrungen mit der Literatur. Material und Methoden: Von 6/96 bis 12/99 wurden 4 Patienten mit AVK der oberen Extremitaet und zwei mit chronischen thorakalen Herpes-zoster-Neuralgien mittels jeweils unilateral durchgefuehrter CT-TSL behandelt. Ergebnisse: 3 von 4 der wegen AVK behandelten Patienten gaben im Verlauf nach 18, 21 und 32 Monaten eine subjektiv empfundene Besserung an, ein Patient hatte unveraendert Beschwerden. Beide Schmerzpatienten zeigten nur kurzfristig eine Verbesserung ihrer Beschwerdesymptomatik. Es traten keine relevanten Komplikationen auf. Schlussfolgerung: Die CT-TSL ist eine alternative Moeglichkeit zur Behandlung der AVK der oberen Extremitaet bei Patienten, die keinem revaskularisierenden Eingriff unterzogen werden koennen

  19. Clinical effect of percutaneous intraluminal radiofrequency ablation combined with biliary stenting and biliary stenting alone in the treatment of malignant obstructive jaundice%腔内射频消融联合胆道支架植入术和单纯胆道支架植入术治疗恶性梗阻性黄疸的临床效果分析

    Institute of Scientific and Technical Information of China (English)

    顼倩茹; 李虎城; 梁峰; 吴田田

    2015-01-01

    目的:比较经皮肝穿刺胆道腔内射频消融联合支架植入术和单纯经皮肝穿刺胆道支架植入术治疗恶性梗阻性黄疸的疗效。方法回顾性地分析2011年4月至2014年9月军事医学科学院附属医院和解放军309医院收治的恶性梗阻性黄疸且不能手术切除患者56例,其中25例行经皮肝穿刺胆道腔内射频消融联合支架植入术(射频组),31例行单纯经皮肝穿刺胆道支架植入术(支架组)。观察治疗前后7~14 d血清总胆红素(TB),直接胆红素( DB)的变化,并对全体患者的手术并发症、支架中位通畅期及患者中位生存期进行比较,通过电话随访或从患者复查记录中获取随访数据。结果手术成功率均为100%,术后均未出现腹膜炎、穿孔等致死性并发症。射频组3例患者及支架组3例患者出现胆管炎,经积极内科保守治疗后缓解。射频组治疗前、治疗后7~14 d TB和DB的变化有显著性意义(P<0.01),支架组治疗前、治疗后7~14 d TB和DB的变化有显著性意义(P<0.01),但7~14 d后射频组TB下降了(149.05±110.71)μmol/L,DB下降了(96.93±69.12)μmol/L;支架组两者分别下降了(151.40±94.47)和(94.21±67.36)μmol/L,两组间TB和DB下降无显著性意义。两组的支架中位通畅期分别为122(9~550)和157(16~510) d,中位生存期分别为125(9~550)和163(16~520) d,两组比较差异无显著性意义。结论腔内射频消融联合支架植入与单纯支架植入均是治疗不能手术切除的恶性梗阻性黄疸有效而安全的方法,两者的近期及远期疗效差异均无明显统计学意义。%Objective To compare the effect of percutaneous intraluminal radiofrequency ablation ( RFA ) combined with biliary stenting and that of percutaneous transhepatic puncture combined with biliary stenting .Methods A total of 56 patients

  20. 射频消融导管联合支架介入治疗恶性梗阻性黄疸的临床研究%Clinical study of percutaneous intraductal radiofrequency ablation plus biliary stenting for malignant biliary obstruction

    Institute of Scientific and Technical Information of China (English)

    赵秋盛; 黄少辉

    2016-01-01

    Objective To investigate the safety and feasibility of percutaneous intraductal radiofrequency ablation(RFA) plus biliary stenting in the treatment of malignant biliary obstruction.Methods Thirteen patients with unresectable malignant obstructive jaundice were selected, then underwent percutaneus intraductal radiofrequency ablation plus metallic biliary stent placement. Clinical efficacy was evaluated by observing the operative complications, remission of jaundice, and the stent patency and survival rate at 1,3,6 months were recorded. Results All the patients underwent the intraductal RFA . No complications such as perforation, biliary leakage or bile peritonitis occurred. Serum total bilirubin was statistical signiifcantly decreased in 1 week[195.4±83.0)μmol/L vs (196.4±148.4)μmol/L,t=5.156,P<0.01], and the jaundice remission rate was 61.5%. The 1,3 month patency rate was 100%, the 6 month patency rate was 80% (8/10). The 1 month survival rate was 100%, The 3,6 month survival rate was 92% (12/13) and 77% (10/13) respectively. Two patients dead of serious drain with advanced tumors in 65,132 days after operation respectively, and one patient dead of disseminated intravascular coagulation in 97 days. Jaundice recurrence occurred in two patients in 4~5 months after the procedure were controlled after received the interventional treatment again.Conclusions Percutaneous intraductal radiofrequency ablation(RFA) can effectively and safely prolong the stent patency and survival time of patients with malignant biliary obstruction, although its long-term efifcacy needs to be further proved.%目的:探讨经皮肝穿刺胆道腔内射频消融(RFA)联合支架介入治疗恶性梗阻性黄疸的效果及安全性。方法纳入无法行手术切除的恶性梗阻性黄疸患者共13例,均接受经皮肝穿刺胆道腔内R FA联合支架植入术,观察手术并发症、黄疸缓解情况并密切随访术后1、3、6个月的支架畅通情况及生存时间

  1. Percutaneous cholecystostomy

    Energy Technology Data Exchange (ETDEWEB)

    Akhan, Okan E-mail: akhano@tr.net; Akinci, Devrim; Oezmen, Mustafa N

    2002-09-01

    Percutaneous cholecystostomy (PC), a technique that consists of percutaneous catheter placement in the gallbladder lumen under imaging guidance, has become an alternative to surgical cholecystostomy in recent years. Indications of PC include calculous or acalculous cholecystitis, cholangitis, biliary obstruction and opacification of biliary ducts. It also provides a potential route for stone dissolution therapy and stone extraction. Under aseptic conditions and ultrasound guidance, using local anesthesia, the procedure is carried out by using either modified Seldinger technique or trocar technique. Transhepatic or transperitoneal puncture can be performed as an access route. Several days after the procedure transcatheter cholangiography is performed to assess the patency of cystic duct, presence of gallstones and catheter position. The tract is considered mature in the absence of leakage to the peritoneal cavity, subhepatic, subcapsular, or subdiaphragmatic spaces. Response rates to PC in the literature are between the range of 56-100% as the variation of different patient population. Complications associated with PC usually occur immediately or within days and include haemorrhage, vagal reactions, sepsis, bile peritonitis, pneumothorax, perforation of the intestinal loop, secondary infection or colonisation of the gallbladder and catheter dislodgment. Late complications have been reported as catheter dislodgment and recurrent cholecystitis. PC under ultrasonographic guidance is a cost-effective, easy to perform and reliable procedure with low complication and high success rates for critically ill patients with acute cholecystitis. It is generally followed by elective cholecystectomy, if possible. However, it may be definitive treatment, especially in acalculous cholecystitis.

  2. Predictors of technical success and rate of complications of image-guided percutaneous transthoracic lung needle biopsy of pulmonary tumors.

    Science.gov (United States)

    Otto, Stephan; Mensel, Birger; Friedrich, Nele; Schäfer, Sophia; Mahlke, Christoph; von Bernstorff, Wolfram; Bock, Karen; Hosten, Norbert; Kühn, Jens-Peter

    2015-01-01

    To investigate predictors of technical success and complications of computed tomography (CT)-guided percutaneous transthoracic needle biopsy of potentially malignant pulmonary tumors. From 2008 to 2009, technical success and rate of complications of CT-guided percutaneous transthoracic lung needle biopsies of patients with suspicious pulmonary tumors were retrospectively evaluated. The influence on technical success and rate of complications was assessed for intervention-related predictors (lesion diameter, length of biopsy pathway, number of pleural transgressions, and needle size) and patient-related predictors (age, gender, reduced lung function). In addition, technical success and rate of complications were compared between different interventional radiologists. One hundred thirty-eight patients underwent biopsies by 15 interventional radiologists. The overall technical success rate was 84.1% and was significantly different between interventional radiologists (range 25%-100%; ptechnical success rate. The overall complication rate was 59.4% with 39.1% minor complications and 21.0% major complications. The rate of complications was influenced by lesion diameter and distance of biopsy pathway. Interventional radiologist-related rates of complications were not statistically different. Technical success of percutaneous, transthoracic lung needle biopsies of pulmonary tumors is probably dependent on the interventional radiologist. In addition, lesion diameter and length of biopsy pathway are predictors of the rate of complications.

  3. Computed tomography-guided percutaneous catheter drainage of primary and secondary iliopsoas abscesses

    Energy Technology Data Exchange (ETDEWEB)

    Cantasdemir, M. E-mail: cantas1@yahoo.com; Kara, B.; Cebi, D.; Selcuk, N.D.; Numan, F

    2003-10-01

    AIM: To report our experience with computed tomography (CT)-guided percutaneous catheter drainage (PCD) of iliopsoas abscesses. MATERIALS AND METHODS: Twenty-two iliopsoas abscesses in 21 patients (11 women, 10 men) aged between 18 and 66 years (mean 36 years) were treated with PCD. Abdominal CT demonstrated the iliopsoas abscesses, which were definitively determined by Gram staining and aspirate cultures. Twenty of the 22 iliopsoas abscesses were primary and two were secondary. All PCD procedures were performed under local anaesthesia using a single-step trocar technique (n=19) or Seldinger technique (n=3). RESULTS: PCD was an effective treatment in 21 out of the 22 iliopsoas abscesses. Recurrence was seen in three abscesses as minimal residual collections. Two of them resolved spontaneously with anti-tuberculous regimen. One required percutaneous needle aspiration. The procedure failed in a diabetic patient with a secondary abscess, who died due to sepsis. The length of time that catheters remained in place ranged from 21 to 75 days (mean 59.7 days). Complications included catheter dislocation in four abscesses, which required removal of dislocated catheters and indwelling new ones. CONCLUSION: CT-guided PCD is a safe and effective front-line treatment of iliopsoas abscesses. Surgery should be reserved for failure of PCD and presence of contraindications to PCD.

  4. Prospective evaluation of the radiologist's hand dose in CT-guided interventions; Prospektive Evaluation der Handdosis des Radiologen im Rahmen von CT-gestuetzten Interventionen

    Energy Technology Data Exchange (ETDEWEB)

    Rogits, B.; Jungnickel, K.; Loewenthal, D.; Dudeck, O.; Pech, M.; Ricke, J. [Magdeburg Univ. (Germany). Radiology and Nuclear Medicine; Kropf, S. [Magdeburg Univ. (Germany). Dept. of Biometry and Medical Informatics; Nekolla, E.A. [The Federal Office for Radiation Protection, Neuherberg (Germany). Dept. of Radiation Protection and Health; Wieners, G. [Charite CVC, Berlin (Germany). Dept. of Radiology

    2013-11-15

    Purpose: Assessment of radiologist's hand dose in CT-guided interventions and determination of influencing factors. Materials and Methods: The following CT-guided interventions were included: Core biopsy, drainage, periradicular therapy, and celiac plexus neurolysis. The hand dose was measured with an immediately readable dosimeter, the EDD-30 (Unfors, Sweden). The default parameters for CT fluoroscopy were 120 kV, 90 mA and a 4 mm slice thickness. All interventions were performed on a 16-slice CT unit (Aquilion 16 Toshiba, Japan). The tumor size, degree of difficulty (1 - 3), level of experience and device parameters (mAs, dose-length product, scan time) were documented. Results: 138 CT-guided interventions (biopsy n = 99, drainage n = 23, pain therapy n = 16) at different locations (lung n = 41, retroperitoneum n = 53, liver n = 25, spine n = 19) were included. The lesion size was 4 - 240 mm (median: 23 mm). The fluoroscopy time per intervention was 4.6 - 140.2 s (median: 24.2 s). The measured hand dose ranged from 0.001 - 3.02 mSv (median: 0.22 mSv). The median hand dose for lung puncture (n = 41) was slightly higher (median: 0.32 mSv, p = 0.01) compared to that for the liver, retroperitoneum and other. Besides physical influencing factors, the degree of difficulty (p = 0.001) and summed puncture depth (p = 0.004) correlated significantly with the hand dose. Conclusion: The median hand dose for different CT-guided interventions was 0.22 mSv. Therefore, the annual hand dose limit would normally only be reached with about 2000 interventions. (orig.)

  5. CT-guided percutaneous lung biopsy: Comparison of conventional CT fluoroscopy to CT fluoroscopy with electromagnetic navigation system in 60 consecutive patients

    Energy Technology Data Exchange (ETDEWEB)

    Grand, David Justin, E-mail: dgrand@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States); Atalay, Michael A., E-mail: matalay@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States); Cronan, John J., E-mail: cronan@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States); Mayo-Smith, William W., E-mail: wmayo-smith@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States); Dupuy, Damian E., E-mail: ddupuy@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States)

    2011-08-15

    Purpose: To determine if use of an electromagnetic navigation system (EMN) decreases radiation dose and procedure time of CT fluoroscopy guided lung biopsy in lesions smaller than 2.5 cm. Materials/methods: 86 consecutive patients with small lung masses (<2.5 cm) were approached. 60 consented and were randomized to undergo biopsy with CT fluoroscopy (CTF) (34 patients) or EMN (26 patients). Technical failure required conversion to CTF in 8/26 EMN patients; 18 patients completed biopsy with EMN. Numerous biopsy parameters were compared as described below. Results: Average fluoroscopy time using CTF was 28.2 s compared to 35.0 s for EMN (p = 0.1). Average radiation dose was 117 mGy using CTF and 123 mGy for EMN (p = 0.7). Average number of needle repositions was 3.7 for CTF and 4.4 for EMN (p = 0.4). Average procedure time was 15 min for CTF and 20 min for EMN (p = 0.01). There were 7 pneumothoracesin the CTF group and 6 pneumothoraces in the EMN group (p = 0.7). One pneumothorax in the CTF group and 3 pneumothoraces in the EMN group required chest tube placement (p = 0.1). One pneumothorax patient in each group required hospital admission. Diagnostic specimens were obtained in 31/34 patients in the CTF group and 22/26 patients in the EMN group (p = 0.4). Conclusions: EMN was not statistically different than CTF for fluoroscopy time, radiation dose, number of needle repositions, incidence of pneumothorax, need for chest tube, or diagnostic yield. Procedure time was increased with EMN.

  6. Evaluation of a Robotic Assistance-System For Percutaneous Computed Tomography-Guided (CT-Guided) Facet Joint Injection: A Phantom Study.

    Science.gov (United States)

    Beyer, Lukas Philipp; Michalik, Katharina; Niessen, Christoph; Platz Batista da Silva, Natascha; Wiesinger, Isabell; Stroszczynski, Christian; Wiggermann, Philipp

    2016-09-20

    BACKGROUND The aim of this study was to compare robotic assisted and freehand facet joint puncture on a phantom model in regards to time requirements and puncture accuracy. MATERIAL AND METHODS Forty facet joints were punctured, 20 using a robotic guidance system and 20 using a freehand procedure. Side and height of the facet joints were randomized and identical for both groups. Procedural accuracy, defined as axial and sagittal deviation, as well as the number of corrections were assessed. Procedure times for each step were documented and time requirements for pre-positioning, reconstruction, planning, and total intervention were calculated. RESULTS Total procedure time for robotic guidance was 259±111 seconds versus 119±77 seconds for freehand procedure (p=1.0). Procedural accuracy for robotic guidance was significantly higher with 0 corrections versus 1.3 corrections for freehand procedure (p=0.02). Needle deviation in the robotics arm was 0.35±1.1 mm in the axial and 2.15±1.2 mm in the sagittal reconstruction. CONCLUSIONS Robotic assisted puncture of the facet joint allowed accurate positioning of the needle with a lower number of needle readjustments. Higher procedural accuracy was marginally offset by a slightly longer intervention time.

  7. Efficacy of computed tomography guided radiofrequency ablation forosteoid osteomas in 31 patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Hoon; Ahn, Joong Mo; Lee, Joon Woo; Lee, Guen Young; Lee, Eu Gene; Oh, Joo Han; Cho, Hwan Seong; Kang, Heung Sik [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2015-04-15

    To present the clinical outcome of computed tomography (CT) guided radiofrequency ablation (RFA) for osteoid osteoma. Thirty-one patients (M:F = 23:8, mean age: 20 years, range: 4-54 years) who underwent RFA for clinically suspected osteoid osteoma from May 2004 to December 2013 were retrospectively reviewed. RFA was done in all cases under CT guidance by one of three radiologists in our department. Electronic medical records and images were retrospectively reviewed in all patients. Lesions were located in femur (n = 20), tibia (n = 5), fibula (n = 2), humerus (n = 3), talus (n = 2), and calcaneus (n = 1). On discharge, 27 of 33 cases showed complete remission of pain (82%). One major complication (compartment syndrome) and 2 minor complications (reactive synovitis, minimal skin burn at electrode insertion site) were observed. On the last follow-up (0-78 months, mean: 12.6 months) 27 of 33 cases were successfully treated (82%) and had no more complaints. 3 cases presented remaining pain (9%). In 3 cases relapse occurred (9%) and RFA was repeated in 1 case. The repeated treatment was successful. CT-guided RFA is an effective method for the treatment of osteoid osteoma.

  8. Preliminary clinical experience with a dedicated interventional robotic system for CT-guided biopsies of lung lesions: a comparison with the conventional manual technique

    Energy Technology Data Exchange (ETDEWEB)

    Anzidei, Michele; Argiro, Renato; Porfiri, Andrea; Boni, Fabrizio; Zaccagna, Fulvio; Napoli, Alessandro; Leonardi, Andrea; Bezzi, Mario; Catalano, Carlo [University of Rome, Department of Radiological, Oncological and Anatomopathological Sciences - Radiology - Sapienza, Rome (Italy); Anile, Marco; Venuta, Federico [University of Rome, Department of Thoracic Surgery - Sapienza, Rome (Italy); Vitolo, Domenico [University of Rome, Department of Radiological, Oncological and Anatomopathological Sciences - Pathology - Sapienza, Rome (Italy); Saba, Luca [Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, Monserrato (Italy); Longo, Flavia [University of Rome, Department of Radiological, Oncological and Anatomopathological Sciences - Oncology - Sapienza, Rome (Italy)

    2015-05-01

    Evaluate the performance of a robotic system for CT-guided lung biopsy in comparison to the conventional manual technique. One hundred patients referred for CT-guided lung biopsy were randomly assigned to group A (robot-assisted procedure) or group B (conventional procedure). Size, distance from entry point and position in lung of target lesions were evaluated to assess homogeneity differences between the two groups. Procedure duration, dose length product (DLP), precision of needle positioning, diagnostic performance of the biopsy and rate of complications were evaluated to assess the clinical performance of the robotic system as compared to the conventional technique. All biopsies were successfully performed. The size (p = 0.41), distance from entry point (p = 0.86) and position in lung (p = 0.32) of target lesions were similar in both groups (p = 0.05). Procedure duration and radiation dose were significantly reduced in group A as compared to group B (p = 0.001). Precision of needle positioning, diagnostic performance of the biopsy and rate of complications were similar in both groups (p = 0.05). Robot-assisted CT-guided lung biopsy can be performed safely and with high diagnostic accuracy, reducing procedure duration and radiation dose in comparison to the conventional manual technique. (orig.)

  9. CT-guided biopsy for Langerhans cell histiocytosis of the atlas: a case report and literature review.

    Science.gov (United States)

    Yang, Biao; Zhan, Rui-Yu; Guo, Wen-Hao; Liao, Zheng-Yin

    2016-07-14

    Langerhans cell histiocytosis (LCH) is a rare disease, and involvement of the atlas is extremely uncommon. Biopsy of atlas lesions is difficult and risky. In this case report, we describe the performance of percutaneous computed tomography-guided biopsy of an atlantal LCH in a patient with no complication.

  10. Thoracic type Ia endoleak: direct percutaneous coil embolization of the aortic arch at the blood entry site after TEVAR and double-chimney stent-grafts

    Energy Technology Data Exchange (ETDEWEB)

    Bangard, Christopher; Franke, Mareike; Maintz, David; Chang, De-Hua [University Hospital, University of Cologne, Department of Radiology, Cologne (Germany); Pfister, Roman [University Hospital, University of Cologne, Department of Internal Medicine III, Cologne (Germany); Deppe, Antje-Christin [University Hospital, University of Cologne, Department of Cardiothoracic Surgery, Cologne (Germany); Matoussevitch, Vladimir [University Hospital, University of Cologne, Department of Vascular Surgery, Cologne (Germany)

    2014-06-15

    To introduce a novel percutaneous technique to stop blood entry at the lesser aortic arch curvature by coil embolisation in type Ia endoleak after TEVAR. A 61-year-old Marfan patient presented with type Ia endoleak of the aortic arch and a growing aortic arch pseudoaneurysm after TEVAR. Multiple preceding operations and interventions made an endovascular approach unsuccessful. Direct percutaneous puncture of the aneurysmal sac would have cured the sign, but not the cause of blood entry at the lesser curvature of the aortic arch. Direct CT-guided percutaneous puncture of the blood entry site in the aortic arch with fluoroscopically guided coil embolisation using detachable extra-long coils was successfully performed. Three weeks after the intervention, the patient developed fever because of superinfection of the pseudoaneurysm. The blood cultures and CT-guided mediastinal aspirate were sterile. After intravenous administration of antibiotics, the fever disappeared and the patient recovered. Six-month follow-up showed permanent closure of the endoleak and a shrinking aneurysmal sac. Direct percutaneous puncture of the aortic arch at the blood entry site of a thoracic type Ia endoleak after TEVAR and double-chimney stent-grafts with coil embolisation of the wedge-shaped space between the lesser aortic curvature and the stent-graft is possible. (orig.)

  11. Percutaneous biopsy of a metastatic common iliac lymph node using hydrodissection and a semi-automated biopsy gun

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Seong Yoon; Park, Byung Kwan [Dept. of Radiology, amsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2017-06-15

    Percutaneous biopsy is a less invasive technique for sampling the tissue than laparoscopic biopsy or exploratory laparotomy. However, it is difficult to perform biopsy of a deep-seated lesion because of the possibility of damage to the critical organs. Recently, we successfully performed CT-guided biopsy of a metastatic common iliac lymph node using hydrodissection and semi-automated biopsy devices. The purpose of this case report was to show how to perform hydrodissection and how to use a semi-automated gun for safe biopsy of a metastatic common iliac lymph node.

  12. Percutaneous computed tomography-guided core needle biopsy of soft tissue tumors: results and correlation with surgical specimen analysis

    Energy Technology Data Exchange (ETDEWEB)

    Chojniak, Rubens; Grigio, Henrique Ramos; Bitencourt, Almir Galvao Vieira; Pinto, Paula Nicole Vieira; Tyng, Chiang J.; Cunha, Isabela Werneck da; Aguiar Junior, Samuel; Lopes, Ademar, E-mail: chojniak@uol.com.br [Hospital A.C. Camargo, Sao Paulo, SP (Brazil)

    2012-09-15

    Objective: To evaluate the efficacy of percutaneous computed tomography (CT)-guided core needle biopsy of soft tissue tumors in obtaining appropriate samples for histological analysis, and compare its diagnosis with the results of the surgical pathology as available. Materials and Methods: The authors reviewed medical records, imaging and histological reports of 262 patients with soft-tissue tumors submitted to CT-guided core needle biopsy in an oncologic reference center between 2003 and 2009. Results: Appropriate samples were obtained in 215 (82.1%) out of the 262 patients. The most prevalent tumors were sarcomas (38.6%), metastatic carcinomas (28.8%), benign mesenchymal tumors (20.5%) and lymphomas (9.3%). Histological grading was feasible in 92.8% of sarcoma patients, with the majority of them (77.9%) being classified as high grade tumors. Out of the total sample, 116 patients (44.3%) underwent surgical excision and diagnosis confirmation. Core biopsy demonstrated 94.6% accuracy in the identification of sarcomas, with 96.4% sensitivity and 89.5% specificity. A significant intermethod agreement about histological grading was observed between core biopsy and surgical resection (p < 0.001; kappa = 0.75). Conclusion: CT-guided core needle biopsy demonstrated a high diagnostic accuracy in the evaluation of soft tissue tumors as well as in the histological grading of sarcomas, allowing an appropriate therapeutic planning (author)

  13. Percutaneous tracheostomy

    Directory of Open Access Journals (Sweden)

    Chitra Mehta

    2017-01-01

    Full Text Available Percutaneous dilatational tracheostomy (PDT is a commonly performed procedure in critically sick patients. It can be safely performed bedside by intensivists.This has resulted in decline in the use of surgical tracheostomy in intensive care unit (ICU except in few selected cases. Most common indication of tracheostomy in ICU is need for prolonged ventilation. About 10% of patients requiring at least 3 days of mechanical ventilator support get tracheostomised during ICU stay. The ideal timing of PDT remains undecided at present. Contraindications and complications become fewer with increase in experience. Various methods of performing PDT have been discovered in last two decades. Preoperative work up, patient selection and post tracheostomy care form key components of a successful PDT. Bronchoscopy and ultrasound have been found to be useful procedural adjuncts, especially in presence of unfavorable anatomy. This article gives a brief overview about the use of PDT in ICU.

  14. Percutaneous gastroenterostomy

    Energy Technology Data Exchange (ETDEWEB)

    Wittich, G.R.; Van Sonnenberg, E.; Casola, G.; Jantsch, H.; Walter, R.; Lechner, G.

    1987-05-01

    Percutaneous gastrostomies or gastroenterostomies serve for temporary or permanent enteric feeding in patients with obstruction or functional derangement of the esophagus or hypopharynx. In addition, this radiological procedure may be indicated for small bowel decompression. The authors present their experience in 71 patients. Insufflation of air through a nasogastric tube or catheter is the preferred method for gastric distension. The inferior margin of the left lobe of the liver and the transverse colon are localized sonographically and fluoroscopically prior to puncture. Either Seldinger or Trocartechniques have proven effective in establishing access to the stomach. The feeding tube is advanced into the proximal jejunum to reduce the likelyhood of gastroesophageal reflux and possible aspiration. Complications were encountered in four patients and included catheter dislocation in three and respiratory distress in one patient.

  15. Clinical application on CT guiding interventional radiology technology%CT导引介人技术的临床应用

    Institute of Scientific and Technical Information of China (English)

    何建华; 彭述文; 米霞

    2011-01-01

    Objective The Computer Tomography (CT) guiding interventional radiology technology already became an extremely adequate technology in the large-scale general hospital, which was brought in since 2008-2009 in our hospital, and it has carried out dozens of cases, we improved it into a new kind of technology suitable for our hospital after summing up and studying it. This technology should be extended for popular use among the primary hospitals. Methods TOSHIBA Activion 16 screw CT scanner was used with the puncture needle Cook19G.After skin lung puncture biopsy 12 cases, after skin kidney puncture 25 cases, after skin liver puncture 7 cases. Results Among 12 cases of lung puncture biopsy, 9 cases are periphery the lung cancer, 2 cases are the pulmonary tuberculoses, 1 cases is pneumonia change in sexuality. 32 cases livers, the kidney puncture biopsy is a cyst, after extracts the pouch fluid to involve the hardened treatment, biggest cyst 11 cm, smallest cyst approximately 6cm, the short-term reexamination cyst obviously reduces approximately, after half year of reexaminations, the cyst disappeared basically or completely. No serious complication occurred. Conclusion The CT guiding interventional radiology technology belongs to the interventional radiology technology category, its application scope is broad, involving the whole body various systems, becoming one of the important methods of clinical diagnosis and treatment domain with characteristics of high security, minimally invasive surgery and less complication, etc. It' s worth to be extended popularly in primary hospitals.%目的 归纳、总结并不断改进我院CT导引介入技术,形成适应本院的一种新技术.方法 使用TOSHIBA Activion 16螺旋CT扫描机.穿刺针为Cook19G.经皮肺穿刺活检12例,经皮肾穿刺25例,经皮肝穿刺7例.结果 12例肺穿刺活检,9例为周围型肺癌,2例为肺结核,1例为肺炎性变.32例肝、肾穿刺活检为囊肿,抽取囊液后介入

  16. PET/CT-guided treatment planning for paediatric cancer patients: a simulation study of proton and conventional photon therapy

    Science.gov (United States)

    Brodin, N P; Björk-Eriksson, T; Birk Christensen, C; Kiil-Berthelsen, A; Aznar, M C; Hollensen, C; Markova, E; Munck af Rosenschöld, P

    2015-01-01

    Objective: To investigate the impact of including fluorine-18 fludeoxyglucose (18F-FDG) positron emission tomography (PET) scanning in the planning of paediatric radiotherapy (RT). Methods: Target volumes were first delineated without and subsequently re-delineated with access to 18F-FDG PET scan information, on duplicate CT sets. RT plans were generated for three-dimensional conformal photon RT (3DCRT) and intensity-modulated proton therapy (IMPT). The results were evaluated by comparison of target volumes, target dose coverage parameters, normal tissue complication probability (NTCP) and estimated risk of secondary cancer (SC). Results: Considerable deviations between CT- and PET/CT-guided target volumes were seen in 3 out of the 11 patients studied. However, averaging over the whole cohort, CT or PET/CT guidance introduced no significant difference in the shape or size of the target volumes, target dose coverage, irradiated volumes, estimated NTCP or SC risk, neither for IMPT nor 3DCRT. Conclusion: Our results imply that the inclusion of PET/CT scans in the RT planning process could have considerable impact for individual patients. There were no general trends of increasing or decreasing irradiated volumes, suggesting that the long-term morbidity of RT in childhood would on average remain largely unaffected. Advances in knowledge: 18F-FDG PET-based RT planning does not systematically change NTCP or SC risk for paediatric cancer patients compared with CT only. 3 out of 11 patients had a distinct change of target volumes when PET-guided planning was introduced. Dice and mismatch metrics are not sufficient to assess the consequences of target volume differences in the context of RT. PMID:25494657

  17. Percutaneous Achilles Tendon Lengthening

    Science.gov (United States)

    ... All Site Content AOFAS / FootCareMD / Treatments Percutaneous Achilles Tendon Lengthening Page Content ​ Pre-operative incision markings along ... What is the goal of a percutaneous Achilles tendon lengthening? The goal of this procedure is to ...

  18. Percutaneous Abscess Drainage

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z Percutaneous Abscess Drainage An abscess is an infected fluid collection ... are the benefits vs. risks? What is Percutaneous Abscess Drainage? An abscess is an infected fluid collection ...

  19. Assessment and management of interfractional variations in daily diagnostic-quality-CT guided prostate-bed irradiation after prostatectomy

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Feng; Ahunbay, Ergun; Lawton, Colleen; Allen Li, X., E-mail: ali@mcw.edu [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226 (United States)

    2014-03-15

    Purpose: To quantify interfractional anatomic variations and limitations of the current practice of image-guided radiation therapy (IGRT) for prostate-bed patients and to study dosimetric benefits of an online adaptive replanning scheme that addresses the interfractional variations. Methods: Contours for the targets and organs at risk (OARs) from daily diagnostic-quality CTs acquired with in-room CT (CTVision, Siemens) were generated by populating the planning contours using an autosegmentation tool based on deformable registration (ABAS, Elekta) with manual editing for ten prostate-bed patients treated with postoperative daily CT-guided IMRT. Dice similarity coefficient (DSC) obtained by maximizing the overlap of contours for a structure between the daily and plan contours was used to quantify the organ deformation between the plan and daily CTs. Three interfractional-variation-correction schemes, the current standard practice of IGRT repositioning, a previously developed online adaptive RT (ART), and the full reoptimization, were applied to these daily CTs and a number of dose-volume quantities for the targets and organs at risk were compared for their effectiveness to account for the interfractional variations. Results: Large interfractional organ deformations in prostate-bed irradiation were seen. The mean DSCs for CTV, rectum, and bladder were 86.6 ± 5.1% (range from 61% to 97%), 77.3% ± 7.4% (range from 55% to 90%), and 75.4% ± 11.2% (range from 46% to 96%), respectively. The fractional and cumulative dose-volume quantities for CTV and PTV: V100 (volume received at least 100% prescription dose), and rectum and bladder: V{sub 45Gy} and V{sub 60Gy} (volume received at least 45 or 60 Gy), were compared for the repositioning, adaptive, reoptimization, and original plans. The fractional and cumulative dosimetric results were nearly the same. The average cumulative CTV V100 were 88.0%, 98.4%, 99.2%, and 99.3% for the IGRT, ART, reoptimization, and original plans

  20. Radiation dose reduction in CT-guided periradicular injections in lumbar spine: Feasibility of a new institutional protocol for improved patient safety

    Directory of Open Access Journals (Sweden)

    Artner Juraj

    2012-08-01

    Full Text Available Abstract Background Image guided spinal injections are successfully used in the management of low back pain and sciatica. The main benefit of CT-guided injections is the safe, fast and precise needle placement, but the radiation exposure remains a serious concern. The purpose of the study was to test a new institutional low-dose protocol for CT-guided periradicular injections in lumbar spine to reduce radiation exposure while increasing accuracy and safety for the patients. Methods We performed a retrospective analysis of a prospective database during a 4-month period (Oct-Dec 2011 at a German University hospital using a newly established low-dose-CT-protocol for periradicular injections in patients suffering from lumbar disc herniation and nerve root entrapment. Inclusion criteria were acute or chronic nerve root irritation due to lumbar disc hernia, age over 18, compliance and informed consent. Excluded were patients suffering from severe obesity (BMI > 30, coagulopathy, allergy to injected substances, infection and non-compliant patients. Outcome parameters consisted of the measured dose length product (mGycm2, the amount of scans, age, gender, BMI and the peri-interventional complications. The results were compared to 50 patients, treated in the standard-interventional CT-protocol for spinal injections, performed in June-Oct 2011, who met the above mentioned inclusion criteria. Results A total amount of 100 patients were enrolled in the study. A significant radiation dose reduction (average 85.31% was achieved using the institutional low-dose protocol compared to standard intervention mode in CT-guided periradicular injections in lumbar spine. Using the low-dose protocol did not increase the complications rate in the analyzed cohort. Conclusions Low-dose-CT-protocols for lumbar perineural injections significantly reduce the exposure to radiation of non-obese patients without an increase of complications. This increases long-time patient

  1. Development of a CT-guided standard approach for tined lead implantation at the sacral nerve root S3 in minipigs for chronic neuromodulation

    Directory of Open Access Journals (Sweden)

    Foditsch EE

    2016-09-01

    Full Text Available Elena Esra Foditsch,1 Reinhold Zimmermann2 1Urology, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 2University Clinic of Urology and Andrology, Salzburg General Hospital, Paracelsus Medical University, Salzburg, Austria Purpose: The aim of this study was to develop a controlled approach for sacral neuromodulation (SNM to improve both nerve targeting and tined lead placement, for which a new computed tomography (CT-guided implantation technique was analyzed in minipigs.Materials and methods: This study included five female, adult Göttingen minipigs. In deep sedoanalgesia, the minipigs were placed in an extended prone position. Commercially available SNM materials were used (needle, introduction sheath, and quadripolar tined lead electrode. Gross anatomy was displayed by CT, and the nerves were bilaterally identified. The optimal angles to puncture the S3 foramen, the resulting access path, and the site for the skin incision were defined subsequently. The needle puncture and the tined lead placement were followed by successive CT scans/3D-reconstruction images. Once proper CT-guided placement of the needle and electrode was established, response to functional stimuli was intraoperatively checked to verify correct positioning.Results: Successful bilateral tined lead implantation was performed in four out of five minipigs. Implantation was different from the clinical situation because the puncture was done from the contralateral side at a 30° angle to the midline and 60° horizontal angle to ensure both passage through the foramen and nerve access. Surgery time was 50–150 minutes. Stimulation response comprised a twitch of the perianal musculature and tail rotation to the contralateral side.Conclusion: We have established a new, minimally invasive, highly standardized, CT-guided SNM electrode implantation technique. Functional outcomes are clearly defined and reproducible. All procedures can be

  2. Uniportal video-assisted thoracic surgery resection of small ground-glass opacities (GGOs) localized with CT-guided placement of microcoils and palpation

    Science.gov (United States)

    Shi, Zhe; Jiang, Sen; Jiang, Gening

    2016-01-01

    Although uniportal video-assisted thoracic surgery (VATS) is becoming more popular, it’s still very challenging to conduct a wedge resection of small pulmonary ground-glass opacities (GGOs), especially deeply situated subpleural GGOs, via uniportal VATS. We successfully performed thirteen uniportal VATS wedge resections through an approach that combines radiologically guided microcoil localization with palpation, and we encountered no complications related to the new approach. Based on our experience, a combination of CT-guided microcoil localization with palpation in uniportal VATS for deeply situated subpleural GGOs is a safe and effective procedure for accurate diag¬nosis and resection of indeterminate GGOs. PMID:27499978

  3. Intraductal radiofrequency ablation for management of malignant biliary obstruction.

    Science.gov (United States)

    Rustagi, Tarun; Jamidar, Priya A

    2014-11-01

    Self-expandable metal stents (SEMS) are the current standard of care for the palliative management of malignant biliary strictures. Recently, endoscopic ablative techniques with direct affect to local tumor have been developed to improve SEMS patency. Several reports have demonstrated the technical feasibility and safety of intraductal radiofrequency ablation (RFA), by both endoscopic and percutaneous approaches, in palliation of malignant strictures of the bile duct. Intraductal RFA has also been used in the treatment of occlusion of both covered and uncovered SEMS occlusion from tumor ingrowth or overgrowth. This article provides a comprehensive review of intraductal RFA in the management of malignant biliary obstruction.

  4. Can the need for colectomy after computed tomography-guided percutaneous drainage for diverticular abscess be predicted?

    Science.gov (United States)

    Felder, Seth I; Barmparas, Galinos; Lynn, Juliane; Murrell, Zuri; Margulies, Daniel R; Fleshner, Phillip

    2013-10-01

    The primary aim of this study was to define predictors of computed tomography (CT)-guided percutaneous abscess drainage treatment failure in complicated diverticulitis. A 10-year retrospective analysis of inpatients seen in surgical consultation for diverticular abscess management subsequently referred for CT-guided percutaneous drainage (PD) was conducted. The clinical courses of patients undergoing a technically successful PD were categorized into three groups: 1) no colectomy; 2) elective colectomy; and 3) nonelective colectomy. Forty study patients were identified. Thirteen (33%) of the 40 patients required a nonelective colectomy, 20 patients (50%) underwent elective resection, and seven patients (18%) have been managed nonoperatively with no recurrent diverticulitis for a median of 46.8 months (range, 3.2 to 84.3 months). Forward logistic regression identified the presence of immunosuppression or renal insufficiency (creatinine 1.5 mg/dL or greater) as factors independently associated with failure of PD and need for nonelective colectomy. No clinical, laboratory, or radiologic variables were predictive of long-term nonoperative success. Although PD allows for the resolution of intra-abdominal sepsis for most cases of diverticulitis complicated by an abscess, a substantial proportion progress to nonelective colectomy, emphasizing the need for clinical vigilance in follow-up.

  5. Successful treatment of multiple hepatocellular adenomas with percutaneous radiofrequency ablation

    OpenAIRE

    Ahn, Sun Young; Park, Soo Young; Kweon, Young Oh; Tak, Won Young; Bae, Han Ik; Cho, Seung Hyun

    2013-01-01

    Hepatocellular adenoma (HCA) is one of the important complications of glycogen storage disease type Ia (GSD-Ia) because it can be transformed into hepatocellular carcinoma. Although surgical resection is a standard treatment of choice for solitary HCA, multiple HCAs in GSD-Ia patients present as therapeutic challenges for curative treatment. Therefore, treatment strategy according to malignant potential is important in management of HCAs in GSD-Ia. The authors present a case of histologically...

  6. Use of spirometry to predict risk of pneumothorax in CT-guided needle biopsy of the lung

    Energy Technology Data Exchange (ETDEWEB)

    Garcia-Rio, F.; Pino, J.M.; Diaz-Lobato, S.; Villamor, S. [Autonoma Univ., Madrid (Spain)] [and others

    1996-01-01

    Our goal was to assess the usefulness of spirometry to estimate the risk of pneumothorax in patients undergoing percutaneous needle biopsy with CT guidance for solitary pulmonary nodule (SPN). We studied the results of 51 consecutive percutaneous needle biopsies with CT guidance for SPN obtained between 1988 and 1990. Forty-five men and six women, aged 65 {+-} 11 (36-86) years, were included in the study. All biopsies were performed under CT guidance, with 90 mm 25G needles (0.5 mm thickness) fitted into luer-type syringes. The number of needle pass attempts never exceeded three. A spirometry before biopsy was performed in all patients. Pneumothorax occurred in only 10 cases (19%). The patients with pneumothorax showed lower lesion size, forced vital capacity (FVC), forced expiratory volume (FEV{sub 1}), and FEV{sub 1}/FVC ratio. The contribution of these factors to pneurnothorax was analyzed by a logistic regression model. The FEV{sub 1} was most strongly associated with the incidence of pneumothorax. We developed an equation for predicting the risk of this complication. We conclude that decreasing FEV{sub 1} is associated with a higher neurnothorax rate. 15 refs., 2 figs., 2 tabs.

  7. Effects of radiofrequency ablation combined with percutaneous vertebroplasty by the injection of artificial bone for metastatic spinal tumor%射频消融联合人工骨椎体成形治疗脊柱转移瘤的疗效分析

    Institute of Scientific and Technical Information of China (English)

    韦溦; 刘洋; 杨星华; 官正华; 金宏伟; 谢志坚; 叶峰

    2015-01-01

    Objective To explore the effects of radiofrequency ablation ( RFA) combined with percutaneous vertebroplasty ( PVP) by the injection of artificial bone for metastatic spinal tumor. Methods Fifty-eight patients with metastatic spinal tumors were divided into bone cement group 1 (n=12),bone cement group 2 (n=16), artificial bone group 1 (n=16), artificial bone group 2 (n=14). The patients in bone cement group were arranged RFA combined with PVP by injection of bone cement,and the artificial bone group were treated with RFA combined with PVP by injection of artificial bone. The vertebral body modality,fractures, and visual analogue scale ( VAS) ,spinal ODI score were compared before operation,1 week,1,3,6,9,12 months of after operation. Results There were 12 patients (42. 9%) with vertebral body deformation in bone cement group,which was more than those in artificial group (6. 7%) (χ2 =8. 4768,P=0. 0036). The VAS or DOI score decreased after operation than those pre-operation in the 4 groups (P<0. 01),but increased in bone cement group after operation of 6, 9 and 12 months than those in artificial group (P<0. 05). Conclusion The combination of RFA and PVP by injection of bone cement or artificial bone is effective to metastatic spinal tumors. The effects of PVP injection with artificial bone maintains longer duration compared to bone cement.%目的:探讨射频消融( RFA)联合注射用人工骨椎体成形术( PVP)治疗脊柱转移瘤的疗效。方法58例脊柱转移瘤患者随机分为骨水泥1组(n=12)、人工骨1组(n=16)、骨水泥2组(n=16)、人工骨2组(n=14),骨水泥组行RFA注射用Ⅲ型丙烯酸树脂骨水泥PVP,人工骨组行RFA联合自固化磷酸钙人工骨PVP。对比分析各组术前及术后1周、1个月、3个月、6个月、9个月、12个月椎体形态及骨折发生率,以及视觉模拟评分( VAS ),脊柱 ODI评分。结果术后随访12个月内骨水泥组12例(42.9%)出现手术椎体或周围椎

  8. Value of spiral CT guided puncture ozone ablation in treatment of cervical disc hernia%螺旋CT引导下经皮颈椎钩突前侧穿刺臭氧消融治疗椎间盘突出的价值

    Institute of Scientific and Technical Information of China (English)

    朱亮旭; 黄河; 邓治强; 李洵; 余文毅

    2011-01-01

    Objective: To evaluate the value of spiral CT guided puncture ozone ablation in treatment of cervical disc hernia. Methods:112 patients with CT or MRI confirmed cervical disc hemia were enrolled in our study, and were treated with CT guided puncture ozone ablation. The treatment schedules were as follows: a total dose of 3~7 ml ozone with the concentration of 60% ~70 % μg/ml was injected into the central of intervertebral disk by needle through the approach of percutaneous-cervical vertebra-anterior border of the uncinate process; when needle was withdrew boundary of intervertebral disk, another ozone was injected with dose of 8~lOml at concentration of 30% ~40% μg/ml, respectively. Results: All patients were followed up for a period of 6 months. The evaluation of therapeutic effect was performed according to MacNab criterion. The therapeutic effects in terms of excellent, good and worse accounted for 42. 9 % (48/112) . 50. 9 % ( 57/112) and 6. 2 % ( 7/112) , respectively. Conclusion: As a minimally invasive method, Spiral CT guided puncture ozone ablation thraugh approach of percutaneous-cervical vertebra-anterior horder of the uncinate process is effective and safe to treat paitents with cervical dise hernia.%目的:探讨螺旋CT引导下经皮颈椎钩突前缘穿刺椎间盘靶点臭氧注射治疗颈椎间盘突出的价值.方法:112例证实经CT或MRI检查诊断为颈椎间盘突出患者,在螺旋CT引导下行穿刺臭氧消融治疗.治疗方式为经皮从颈椎钩突前侧进针,穿刺深度达到椎间盘中心部位注入3~7ml臭氧,浓度为60%~70%ug/ml;然后退针至钩突前侧椎间盘边缘注入8~10ml臭氧,浓度为30%~40%ug/ml.结果:对112例患者术后随访6个月,并按照疗效评价标准对治疗效果进行评定:效果优48例(48/112,占42.9%),效果良57例(57/112,占50.9%),效果差7例(7/112,占6.2%),优良率93.8%.结论:螺旋CT引导下经皮颈椎钩突穿刺椎间盘注射臭

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

    Energy Technology Data Exchange (ETDEWEB)

    Aubry, Sebastien; Kastler, Bruno [University Hospital of Besancon, Department of Musculoskeletal Imaging, Besancon (France); University of Franche-Comte, I4S laboratory, INSERM EA4268, Besancon (France); Dubut, Jonathan; Nueffer, Jean-Philippe [University Hospital of Besancon, Department of Musculoskeletal Imaging, Besancon (France); Chaigneau, Loic [University Hospital of Besancon, Department of Oncology, Besancon (France); Vidal, Chrystelle [University Hospital of Besancon, Clinical Investigation Center, INSERM CIT808, Besancon (France)

    2017-04-15

    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. 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. 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. CT-guided MWA of bone and soft-tissue malignant tumours is efficient, well tolerated and has good short-term anti-cancer effects. (orig.)

  10. CT-guided infiltration saves surgical intervention and fastens return to work compared to anatomical landmark-guided infiltration in patients with lumbosciatica.

    Science.gov (United States)

    Deml, Moritz C; Buhr, Michael; Wimmer, Matthias D; Pflugmacher, Robert; Riedel, Rainer; Rommelspacher, Yorck; Kabir, Koroush

    2015-07-01

    Infiltration procedures are a common treatment of lumbar radiculopathy. There is a wide variety of infiltration techniques without an established gold standard. Therefore, we compared the effectiveness of CT-guided transforaminal infiltrations versus anatomical landmark-guided transforaminal infiltrations at the lower lumbar spine in case of acute sciatica at L3-L5. A retrospective chart review was conducted of 107 outpatients treated between 2009 and 2011. All patients were diagnosed with lumbar radiculopathic pain secondary to disc herniation in L3-L5. A total of 52 patients received CT-guided transforaminal infiltrations; 55 patients received non-imaging-guided nerve root infiltrations. The therapeutic success was evaluated regarding number of physician contacts, duration of treatment, type of analgesics used and loss of work days. Defined endpoint was surgery at the lower lumbar spine. In the CT group, patients needed significantly less oral analgesics (p lumbosciatica caused by intervertebral disc herniation is significantly superior to non-imaging, anatomical landmark-guided infiltration, regarding the parameters investigated. The high number of treatment failures in the non-imaging group underlines the inferiority of this treatment concept.

  11. Application study of vertebral column metastasis tumor with embedment of 125I by CT guide%CT引导下植入125I放射粒子治疗脊柱溶骨性转移瘤

    Institute of Scientific and Technical Information of China (English)

    王歧峰; 胡效坤; 李子祥

    2014-01-01

    目的 探讨CT引导下植入125I放射粒子治疗脊柱溶骨性转移瘤的方法、疗效、安全性.方法 回顾分析山东省平阴县人民医院放射科和青岛大学附属医院介入医学中心自2004年9月至2012年3月收治的31例脊柱溶骨性转移瘤患者,行CT引导下经皮穿刺植入125I放射粒子治疗.应用放射性粒子近距离治疗计划系统(BI-TPSTM)计划125I放射粒子的活度和用量,处方剂量PD为110 ~ 140 Gy,粒子活度为26.0 ~ 29.6 Mbq/颗,术后行CT扫描并进行质量验证,定期CT随访,分析疗效.31例脊柱溶骨性转移瘤患者,分别于术后2、4、6、12个月复查CT,观察肿瘤变化,统计肿瘤局部控制有效率(RR),评价疼痛缓解情况.结果 19例合并椎旁软组织肿块患者2、4、6、12个月肿瘤RR依次是:19/19、19/19、18/19、17/19例;31例患者治疗后2、4、6、12个月疼痛降低1~3级的缓解率依次是96.8% (30/31)、96.8% (30/31)、90.3% (28/31)、71.0% (22/31);3例(9.68%)在植入部位被破坏的骨质内出现了明显的骨化.12例治疗后1个月出现皮肤色素沉着,未见脊髓坏死和皮肤溃疡.结论 CT引导下植入125I放射粒子治疗脊柱溶骨性转移瘤,疗效可靠、安全性高.%Objective To discuss the method,safety and effect of embedding 125I to Brachytherapy vertebral column metastasis tumor by CT guided.Methods 31 cases of vertebral column metastasis tumor were treated with percutaneous embedding 125I by CT guided.They were observed the preoperative size and contour of lesions and were planed the activity and dosage of 125I,the PD (prescribed dose) was 110-140 Gy,and the particle activity was 26.0-29.6 Mbq.CT scanning and therapeutic effect analysis were immediately carried out after operations.We also made CT scanning regularly to analyze the effect.Results 31 cases of vertebral column metastasis tumor were respectively re-examed of CT in 2,4,6 and 12 months after operation.We surveyed the local rate

  12. Radiofrequency ablation of chondroblastoma using a multi-tined expandable electrode system: initial results

    Energy Technology Data Exchange (ETDEWEB)

    Tins, Bernhard; Cassar-Pullicino, Victor; McCall, Iain [RJAH Orthopaedic and District Hospital, Department of Radiology, Oswestry (United Kingdom); Cool, Paul [RJAH Orthopaedic and District Hospital, Musculoskeletal Tumour Unit, Oswestry (United Kingdom); Williams, David [Hereford Hospital, Department of Orthopaedics, Hereford (United Kingdom); Mangham, David [RJAH Orthopaedic and District Hospital, Department of Pathology, Oswestry (United Kingdom)

    2006-04-15

    The standard treatment for chondroblastoma is surgery, which can be difficult and disabling due to its apo- or epiphyseal location. Radiofrequency (RF) ablation potentially offers a minimally invasive alternative. The often large size of chondroblastomas can make treatment with plain electrode systems difficult or impossible. This article describes the preliminary experience of RF treatment of chondroblastomas with a multi-tined expandable RF electrode system. Four cases of CT guided RF treatment are described. The tumour was successfully treated in all cases. In two cases, complications occurred; infraction of a subarticular chondroblastoma in one case and cartilage and bone damage in the unaffected compartment of a knee joint in the other. Radiofrequency treatment near a joint surface threatens the integrity of cartilage and therefore long-term joint function. In weight-bearing areas, the lack of bone replacement in successfully treated lesions contributes to the risk of mechanical failure. Multi-tined expandable electrode systems allow the treatment of large chondroblastomas. In weight-bearing joints and lesions near to the articular cartilage, there is a risk of cartilage damage and mechanical weakening of the bone. In lesions without these caveats, RF ablation appears promising. The potential risks and benefits need to be evaluated for each case individually. (orig.)

  13. Radiofrequency ablation of a cervical osteoid osteoma: a trans-thyroid approach

    Energy Technology Data Exchange (ETDEWEB)

    Sutphen, Sean A.; Murakami, James W. [Columbus Children' s Hospital, Children' s Radiological Institute, Columbus, OH (United States)

    2007-01-15

    We present a 16-year-old girl with an osteoid osteoma in the vertebral body of C5. Given the difficulty of surgically treating the lesion, radiofrequency ablation was used. Percutaneous needle access to this lesion in the anterior aspect of the cervical vertebral body was limited by the many critical adjacent structures. We present our successful treatment of this lesion utilizing a transthyroid needle approach. (orig.)

  14. Dose-volume parameters and clinical outcome of CT-guided free-hand high-dose-rate interstitial brachytherapy for cervical cancer

    Science.gov (United States)

    Wang, Yi; Ye, Wei-Jun; Du, Le-Hui; Li, Ai-Ju; Ren, Yu-Feng; Cao, Xin-Ping

    2012-01-01

    Currently, image-based 3-dimentional (3D) planning brachytherapy allows for a better assessment of gross tumor volume (GTV) and the definition and delineation of target volume in cervix cancer. In this study, we investigated the feasibility of our novel computed tomography (CT)-guided free-hand high-dose-rate interstitial brachytherapy (HDRISBT) technique for cervical cancer by evaluating the dosimetry and preliminary clinical outcome of this approach. Dose-volume histogram (DVH) parameters were analyzed according to the Gynecological GEC-ESTRO Working Group recommendations for image-based 3D treatment in cervical cancer. Twenty cervical cancer patients who underwent CT-guided free-hand HDRISBT between March 2009 and June 2010 were studied. With a median of 5 (range, 4–7) implanted needles for each patient, the median dose of brachytherapy alone delivered to 90% of the target volume (D90) was 45 (range, 33–54) Gyα/β10 for high-risk clinical target volume (HR-CTV) and 30 (range, 20–36) Gyα/β10 for intermediate-risk clinical target volume (IR-CTV). The percentage of the CTV covered by the prescribed dose (V100) of HR-CTV with brachytherapy alone was 81.9%–99.2% (median, 96.7%). With an additional dose of external beam radiotherapy (EBRT), the median D90 was 94 (range, 83–104) Gyα/β10 for HR-CTV and 77 (range, 70–87) Gyα/β10 for IR-CTV; the median dose delivered to 100% of the target volume (D100) was 75 (range, 66–84) Gyα/β10 for HR-CTV and 65 (range, 57–73) Gyα/β10 for IR-CTV. The minimum dose to the most irradiated 2 cc volume (D2cc) was 73–96 (median, 83) Gyα/β3 for the bladder, 64–98 (median, 73) Gyα/β3 for the rectum, and 52–69 (median, 61) Gyα/β3 for the sigmoid colon. After a median follow-up of 15 months (range, 3–24 months), two patients experienced local failure, and 1 showed internal iliac nodal metastasis. Despite the relatively small number of needles used, CT-guided HDRISBT for cervical cancer showed favorable

  15. Dose-volume parameters and clinical outcome of CT-guided freehand high-dose-rate interstitial brachytherapy for cervical cancer

    Institute of Scientific and Technical Information of China (English)

    Yi Wang; Wei-Jun Ye; Le-Hui Du; Ai-Ju Li; Yu-Feng Ren; Xin-Ping Cao

    2012-01-01

    Currently,image-based 3-dimentional (3D) planning brachytherapy allows for a better assessment of gross tumor volume (GTV) and the definition and delineation of target volume in cervix cancer.In this study,we investigated the feasibility of our novel computed tomography (CT)-guided free-hand high-doserate interstitial brachytherapy (HDRISBT) technique for cervical cancer by evaluating the dosimetry and preliminary clinical outcome of this approach.Dose-volume histogram (DVH) parameters were analyzed according to the Gynecological GEC-ESTRO Working Group recommendations for image-based 3D treatment in cervical cancer.Twenty cervical cancer patients who underwent CT-guided free-hand HDRISBT between March 2009 and June 2010 were studied.With a median of 5 (range,4-7) implanted needles for each patient,the median dose of brachytherapy alone delivered to 90% of the target volume (D90) was 45 (range,33-54) Gyα/β10 for high-risk clinical target volume (HR-CTV) and 30 (range,20-36)Gyα/β10 for intermediate-risk clinical target volume (IR-CTV).The percentage of the CTV covered by the prescribed dose (V100) of HR-CTV with brachytherapy alone was 81.9%-99.2% (median,96.7%).With an additional dose of external beam radiotherapy (EBRT),the median D90 was 94 (range,83-104) Gyα/β10 for HR-CTV and 77 (range,70-87) Gyα/β10 for IR-CTV; the median dose delivered to 100% of the target volume (D100) was 75 (range,66-84) Gyα/β10 for HR-CTV and 65 (range,57-73) Gyα/β10 for IR-CTV.The minimum dose to the most irradiated 2 cc volume (D2cc) was 73-96 (median,83) Gyα/β3 for the bladder,64-98 (median,73) Gyα/β3 for the rectum,and 52-69 (median,61) Gyα/β3 for the sigmoid colon.After a median follow-up of 15 months (range,3-24 months),two patients experienced local failure,and 1 showed internal lilac nodal metastasis.Despite the relatively small number of needles used,CT-guided HDRISBT for cervical cancer showed favorable DVH parameters and clinical outcome.

  16. Diagnostic accuracy and complication rate of CT-guided fine needle aspiration biopsy of lung lesions: A study based on the experience of the cytopathologist

    Energy Technology Data Exchange (ETDEWEB)

    Massimiliano Priola, Adriano; Priola, Sandro Massimo; Cataldi, Aldo; Paze, Francesco (Dept. of Diagnostic and Interventional Radiology, Univ. of Turin, S. Luigi Gonzaga Hospital, Turin (Italy)), e-mail: adriano.priola@inwind.it; Di Franco, Marisa (Dept. of Pharmacology, S. Luigi Gonzaga Hospital, Orbassano, Turin (Italy)); Marci, Valerio (Dept. of Pathology, S. Luigi Gonzaga Hospital, Orbassano, Turin (Italy)); Berruti, Alfredo (Dept. of Oncology, S. Luigi Gonzaga Hospital, Orbassano, Turin (Italy))

    2010-06-15

    Background: CT-guided transthoracic needle biopsy is a well-established technique for the diagnosis of focal lung lesions. Fine needle aspiration biopsy (FNAB) requires the presence of a cytopathologist on-site to assess the adequacy of samples. For this reason FNAB is less and less used, and core biopsy is the first-line procedure when an experienced cytopathologist is not immediately available. Purpose: To evaluate the accuracy and complication rate of CT-guided FNAB of lung lesions according to the experience of the cytopathologist on-site. Material and Methods: A total of 321 consecutive biopsies were considered. Immediate cytological assessment was performed by an experienced cytopathologist for the first 165 procedures (group A) and by two training pathologists for the remaining 156 biopsies (group B). At the time of FNAB the pathologist assigned a semiquantitative score (0-3) to each specimen to assess its diagnostic quality. All variables between the two groups were analyzed by chi-square and Student's t test. A P value <0.05 was considered statistically significant. Results: For all procedures, overall diagnostic accuracy was 80% for cytology alone, with no statistical difference between the two groups for diagnostic accuracy and sample score assigned. In all, 75% of the cytological samples (75% group A, 74% group B) obtained a higher score with a specific diagnosis of histotype. A post biopsy pneumothorax was detected in 27% of biopsies (25% group A, 28% group B). Thirteen patients (4.0%) required chest tube insertion for treatment. For all cases, the pneumothorax rate was significantly affected by the number of samples obtained (P=0.02), but not by the pleural punctures (P=0.15). There was no statistically significant difference between the two groups concerning the number of needle passes and complication rate (P>0.05). Conclusion: The efficacy and safety of CT-guided FNAB is not significantly affected by the training level of the cytopathologist

  17. Application of radiofrequency thermocoagulation combined with adriamycin injection in dorsal root ganglia for controlling refractory pain induced by rib metastasis of lung cancer (a STROBE-compliant article).

    Science.gov (United States)

    Xie, Guang-Lun; Guo, Da-Peng; Li, Zhi-Gang; Liu, Chang; Zhang, Wei

    2016-10-01

    This study aimed to observe the therapeutic effects and adverse reactions of radiofrequency thermocoagulation combined with adriamycin injection in dorsal root ganglia on lung cancer rib metastasis-related refractory pain which has no response to conventional therapy.This study contained 27 patients with lung cancer rib metastasis-related moderate or severe pain which had no response to conventional therapy. Under computed tomography (CT)-guidance, radiofrequency puncture need reached the corresponding intervertebral foramens to ensure needle point near dorsal root ganglia (DRG) by sensory and motor stimulation tests, and then radiofrequency thermocoagulation was performed on each corresponding DRG followed by injection of 0.5 to 1 mL of adriamycin (0.5%). The conditions of pain and complications were observed before management and 3 days, 1 month, and 3 months after management, respectively.Numerical rating scale (NRS) scores and dosage of morphine were all significantly decreased after management as compared with those before management (all P management as compared with that before management (all P management in nausea and vomiting, and constipation.CT-guided radiofrequency thermocoagulation combined with adriamycin injection in DRG can effectively control lung cancer rib metastasis-related pain which has no response to conventional therapy. This combinatory treatment regimen is featured by better therapeutic effects and a few complications, so it is worthy of being recommended in clinical application.

  18. Application of radiofrequency thermocoagulation combined with adriamycin injection in dorsal root ganglia for controlling refractory pain induced by rib metastasis of lung cancer (a STROBE-compliant article)

    Science.gov (United States)

    Xie, Guang-lun; Guo, Da-peng; Li, Zhi-gang; Liu, Chang; Zhang, Wei

    2016-01-01

    Abstract This study aimed to observe the therapeutic effects and adverse reactions of radiofrequency thermocoagulation combined with adriamycin injection in dorsal root ganglia on lung cancer rib metastasis-related refractory pain which has no response to conventional therapy. This study contained 27 patients with lung cancer rib metastasis-related moderate or severe pain which had no response to conventional therapy. Under computed tomography (CT)-guidance, radiofrequency puncture need reached the corresponding intervertebral foramens to ensure needle point near dorsal root ganglia (DRG) by sensory and motor stimulation tests, and then radiofrequency thermocoagulation was performed on each corresponding DRG followed by injection of 0.5 to 1 mL of adriamycin (0.5%). The conditions of pain and complications were observed before management and 3 days, 1 month, and 3 months after management, respectively. Numerical rating scale (NRS) scores and dosage of morphine were all significantly decreased after management as compared with those before management (all P management as compared with that before management (all P management in nausea and vomiting, and constipation. CT-guided radiofrequency thermocoagulation combined with adriamycin injection in DRG can effectively control lung cancer rib metastasis-related pain which has no response to conventional therapy. This combinatory treatment regimen is featured by better therapeutic effects and a few complications, so it is worthy of being recommended in clinical application. PMID:27749531

  19. Percutaneous mitral valve repair.

    Science.gov (United States)

    Gillinov, A Marc; Liddicoat, John R

    2006-01-01

    Surgical mitral valve repair is the procedure of choice to treat mitral regurgitation of all etiologies. Whereas annuloplasty is the cornerstone of mitral valve repair, a variety of other surgical techniques are utilized to correct dysfunction of the leaflets and subvalvular apparatus; in most cases, surgical repair entails application of multiple repair techniques in each patient. Preclinical studies and early human experience have demonstrated that some of these surgical repair techniques can be performed using percutaneous approaches. Specifically, there has been great progress in the development of novel technology to facilitate percutaneous annuloplasty and percutaneous edge-to-edge repair. The objectives of this report were to (1) discuss the surgical foundations for these percutaneous approaches; (2) review device design and experimental and clinical results of percutaneous valve repair; and (3) address future directions, including the key challenges of patient selection and clinical trial design.

  20. Combined Fluoroscopy- and CT-Guided Transthoracic Needle Biopsy Using a C-Arm Cone-Beam CT System: Comparison with Fluoroscopy-Guided Biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Cheung, Joo Yeon; Kim, Yoo Kyung; Shim, Sung Shine; Lim, Soo Mee [School of Medicine, Ewha Womans University, Seoul (Korea, Republic of)

    2011-02-15

    The aim of this study was to evaluate the usefulness of combined fluoroscopy- and CT-guided transthoracic needle biopsy (FC-TNB) using a cone beam CT system in comparison to fluoroscopy-guided TNB (F-TNB). We retrospectively evaluated 74 FC-TNB cases (group A) and 97 F-TNB cases (group B) to compare their respective diagnostic accuracies according to the size and depth of the lesion, as well as complications, procedure time, and radiation dose. The sensitivity for malignancy and diagnostic accuracy for small (< 30 mm in size) and deep ({>=} 50 mm in depth) lesions were higher in group A (91% and 94%, 92% and 94%) than in group B (73% and 81%, 84% and 88%), however not statistically significant (p > 0.05). Concerning lesions {>=} 30 mm in size and < 50 mm in depth, both groups displayed similar results (group A, 91% and 92%, 80% and 87%: group B, 90% and 92%, 86% and 90%). Pneumothorax occurred 26% of the time in group A and 14% for group B. The mean procedure time and patient skin dose were significantly higher in group A (13.6 {+-} 4.0 minutes, 157.1 {+-} 76.5 mGy) than in group B (9.0 {+-} 3.5 minutes, 21.9 {+-} 15.2 mGy) (p < 0.05). Combined fluoroscopy- and CT-guided TNB allows the biopsy of small (< 30 mm) and deep lesions ({>=} 50 mm) with high diagnostic accuracy and short procedure times, whereas F-TNB is still a useful method for large and superficial lesions with a low radiation dose

  1. Diffusion-weighted imaging for pretreatment evaluation and prediction of treatment effect in patients undergoing CT-guided injection for lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Niu, Xiang Ke [Dept. of Radiology, Affiliated Hospital of Chengdu University, Chengdu (China); Bhetuwal, Anup; Yang, Han Feng [Schuan Key Laboratory of Medical Imaging and Dept. of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong (China)

    2015-08-15

    To determine whether a change in apparent diffusion coefficient (ADC) value could predict early response to CT-guided Oxygen-Ozone (O{sub 2}-O{sub 3}) injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation. A total of 52 patients with unilateral mono-radiculopathy received a single intradiscal (3 mL) and periganglionic (5 mL) injection of an O{sub 2}-O{sub 3} mixture. An ADC index of the involved side to the intact side was calculated using the following formula: pre-treatment ADC index = ([ADC involved side - ADC intact side] / ADC intact side) x 100. We analyzed the relationship between the pre-treatment Oswestry Disability Index (ODI) and the ADC index. In addition, the correlation between ODI recovery ratio and ADC index was investigated. The sensitivity and specificity of the ADC index for predicting response in O{sub 2}-O{sub 3} therapy was determined. Oswestry Disability Index and the ADC index was not significantly correlated (r = -0.125, p = 0.093). The ADC index and ODI recovery ratio was significantly correlated (r = 0.819, p < 0.001). When using 7.10 as the cut-off value, the ADC index obtained a sensitivity of 86.3% and a specificity of 82.9% for predicting successful response to therapy around the first month of follow-up. This preliminary study demonstrates that the patients with decreased ADC index tend to show poor improvement of clinical symptoms. The ADC index may be a useful indicator to predict early response to CT-guided O{sub 2}-O{sub 3} injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation.

  2. Using a laser guidance system for CT-guided biopsy and treatment of nerve block; Verwendung eines Laserzielgeraetes fuer CT-gesteuerte Biopsien und Nervenblockaden

    Energy Technology Data Exchange (ETDEWEB)

    Zwaan, M. [Inst. fuer Radiologie, Medizinische Univ. Luebeck (Germany); Frahm, C. [Inst. fuer Radiologie, Medizinische Univ. Luebeck (Germany); Kloess, W. [Inst. fuer Radiologie, Medizinische Univ. Luebeck (Germany); Preuss, S. [Schmerzambulanz, Klinik fuer Anaesthesiologie, Medizinische Univ. Luebeck (Germany); Baumeier, W. [Schmerzambulanz, Klinik fuer Anaesthesiologie, Medizinische Univ. Luebeck (Germany); Grande-Nagel, I. [Inst. fuer Radiologie, Medizinische Univ. Luebeck (Germany); Gehl, H.B. [Inst. fuer Radiologie, Medizinische Univ. Luebeck (Germany); Weiss, H.D. [Inst. fuer Radiologie, Medizinische Univ. Luebeck (Germany)

    1996-07-01

    CT-guided intervention is a simple and pin-pointed modality for obtaining cytologic, biopsy, or microbiologic samples, and for treatment of the nerve blockade. In order to enhance the precision of punctures, and reduce complications, the authors developed and tested a novel laser guidance system (wavelength 365 nm at 4.5 mW). In 56 consecutive patients (representing 24 nerve blocks, 16 tumor biopsies, 16 microbiological punctures), a CT-guided intervention was performed. Despite a high accuracy (80 punctures), false punctures (6) could not be avoided in cases where anatomic conditions were misleading the needle, or due to patient movements. The system is not to be blamed for these unsuccessful attempts. As the system operates contactless guided by laser light, it is a good tool ensuring simple and sterile needle biopsy. (orig.) [Deutsch] Die computertomographisch gesteuerte Intervention ist ein einfaches und zielsicheres Verfahren fuer die Gewinnung zystologischer, bioptischer oder mikrobiologischer Proben und zur therapeutischen Nervenblockade. Zur Erhoehung der Punktionsgenauigkeit und zur Reduktion von Komplikationen haben wir fuer diese Indikationsgebiete ein neu entwickeltes Laserzielgeraet (Wellenlaenge 365 m bei 4,5 mW) erprobt. Es wurde bei 56 konsekutiven Patienten (24 Nervenblockaden, 16 Tumorbiopsien, 16 mikrobiologische Materialentnahmen) eine CT-gesteuerte Intervention duchgefuehrt. Trotz einer hohen Treffgenauigkeit (80 Punktionen) kann es aber weiterhin zu Fehlpunktionen (6) kommen, falls Koerperstrukturen zum Abweichen oder Abbiegen der Punktionsnadel fuehren oder der Patient sich bewegt. Dies ist dem System selbst nicht anzulasten. Da es mit Laserlicht beruehrungsfrei arbeitet, ist eine einfache und sterile Punktion sehr gut moeglich. (orig.)

  3. CT-guided corticosteroid injection of the sacroiliac joints: quality assurance and standardized prospective evaluation of long-term effectiveness over six months.

    Science.gov (United States)

    Althoff, Christian E; Bollow, Matthias; Feist, Eugen; Marticorena-Garcia, Stephan R; Eshed, Iris; Diekhoff, Torsten; Hamm, Bernd; Hermann, Kay Geert A

    2015-06-01

    Steroid injection of the sacroiliac joints is widely used for the management of active sacroiliitis in patients with spondyloarthritis (SpA). The aims of this study were to prospectively investigate the effectiveness of corticosteroid injection of the sacroiliac joints and to identify factors determining positive and negative outcome. Twenty-nine patients (18 female, 11 male) suffering from sacroiliitis were treated by computed tomography (CT)-guided administration of 40 or 60 mg triamcinolone acetonide per joint. Clinical outcome of the intervention was determined using a visual analog scale from days 1 to 7 as well as after 1, 3, and 6 months. Patients were grouped according to intra-articular (n = 22) and peri-articular positions (n = 7) of the tip of the puncture needle. In patients with intra-articular needle position (76 %), the mean pain score decreased significantly from 7.3 (±1.9) to 3.9 (±3.4) at day 7 and to 3.9 (±3.4) after 1 month, 4.2 (±3.3) after 3 months, and 5.2 (±2.9) after 6 months. The group with peri-articular needle position (24 %) did not show a statistically significant pain reduction throughout the entire 6-month follow-up period. A substantial reduction of inflammatory back pain (reduction of at least 4 visual analog scale (VAS) points) was reported by 55 % of patients after 3 months and 45 % of patients after 6 months. Our results demonstrate that intra-articular CT-guided steroid instillation can achieve sufficient pain and symptom control for 6 months in patients suffering from active sacroiliitis. It is therefore recommended to perform this intervention under appropriate image guidance to ensure proper positioning of the needle tip.

  4. Complications in CT-guided, semi-automatic coaxial core biopsy of potentially malignant pulmonary lesions; Komplikationen bei CT-gesteuerter, koaxialer Stanzbiopsie malignomverdaechtiger Lungenherde in halbautomatischer Technik

    Energy Technology Data Exchange (ETDEWEB)

    Schulze, R. [Klinik Loewenstein (Germany). Dept. of Radiology; Seebacher, G.; Enderes, B.; Kugler, G.; Graeter, T.P. [Klinik Loewenstein (Germany). Dept. of Thoracic and Vascular Surgery; Fischer, J.R. [Klinik Loewenstein (Germany). Dept. of Oncology

    2015-08-15

    Histological verification of pulmonary lesions is important to ensure correct treatment. Computed tomographic (CT) transthoracic core biopsy is a well-established procedure for this. Comparison of available studies is difficult though, as technical and patient characteristics vary. Using a standardized biopsy technique, we evaluated our results for CT-guided coaxial core biopsy in a semi-automatic technique. Within 2 years, 664 consecutive transpulmonary biopsies were analyzed retrospectively. All interventions were performed using a 17/18G semi-automatic core biopsy system (4 to 8 specimens). The incidence of complications and technical and patient-dependent risk factors were evaluated. Comparing the histology with the final diagnosis, the sensitivity was 96.3 %, and the specificity was 100 %. 24 procedures were not diagnostic. In all others immunohistological staining was possible. The main complication was pneumothorax (PT, 21.7 %), with chest tube insertion in 6 % of the procedures (n = 40). Bleeding without therapeutic consequences was seen in 43 patients. There was no patient mortality. The rate of PT with chest tube insertion was 9.6 % in emphysema patients and 2.8 % without emphysema (p = 0.001). Smokers with emphysema had a 5 times higher risk of developing PT (p = 0.001). Correlation of tumor size or biopsy angle and the risk of PT was not significant. The risk of developing a PT was associated with an increasing intrapulmonary depth of the lesion (p = 0.001). CT-guided, semiautomatic coaxial core biopsy of the lung is a safe diagnostic procedure. The rate of major complications is low, and the sensitivity and specificity of the procedure are high. Smokers with emphysema are at a significantly higher risk of developing pneumothorax and should be monitored accordingly.

  5. The Place of Computed Tomography as a Guidance Modality in Percutaneous Nephrostomy: Analysis of a 10-Year Single-Center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Egilmez, H.; Oztoprak, I.; Atalar, M.; Cetin, A.; Gumus, C.; Gultekin, Y.; Bulut, S.; Arslan, M.; Solak, O. [Depts. of Radiology, Obstetrics and Gynecology, and Urology, Cumhuriyet Univ. School of Medicine, Sivas (Turkey)

    2007-09-15

    Background: Percutaneous nephrostomy (PCN) has been established as an effective technique for urinary decompression or diversion. This procedure may be performed with the guidance of fluoroscopy, ultrasonography, a combination of fluoroscopy and ultrasonography, computed tomography (CT), or magnetic resonance imaging. Purpose: To retrospectively review experience with CT-guided PCN over a 10-year period in a single center. Material and Methods: All CT-guided PCN procedures performed in adults at our institution between 1995 and 2005 were evaluated. In 882 patients, 1113 nephrostomy catheters were inserted. Interventional radiologists or radiology residents under direct attending supervision inserted all catheters. During the PCN procedure, bleeding, sepsis, and injuries to adjacent organs were regarded as major complications. Clinical events requiring nominal therapy with no sequelae were regarded as minor complications. Results: PCN procedures were performed via 1-3 punctures in patients with grades 0-1 and 2 hydronephrosis, and via 1-2 punctures in patients with grade 3 hydronephrosis. They were carried out with a procedure time ranging from 9 to 26 min. All PCNs were considered as technically successful, and no major complications were observed. There were minor complications including transient macroscopic hematuria (28.6%, 19.9%, and 4.9% in patients with hydronephrosis grades 0-1, 2, and 3, respectively) and perirenal hematomas in a total of eight patients. No patient required additional intervention secondary to complications of the PCN procedure. Conclusion: CT-guided PCN is an efficient and safe procedure with major and minor complication rates below the accepted thresholds. It can be used for the management of patients requiring nephrostomy insertion in inpatient settings, and might be a preferable procedure in patients with minimal or no dilatation of the renal pelvis. Keywords: Computed tomography; percutaneous nephrostomy; urinary obstruction.

  6. Comparison of laparoscopic