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Girardet R, Knebel JF, Dromain C, Vietti Violi N, Tsoumakidou G, Villard N, Denys A, Halkic N, Demartines N, Kobayashi K, Digklia A, Schaefer N, Prior JO, Boughdad S, Duran R. Anatomical Quantitative Volumetric Evaluation of Liver Segments in Hepatocellular Carcinoma Patients Treated with Selective Internal Radiation Therapy: Key Parameters Influencing Untreated Liver Hypertrophy. Cancers (Basel) 2024; 16:586. [PMID: 38339337 PMCID: PMC10854872 DOI: 10.3390/cancers16030586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Factors affecting morphological changes in the liver following selective internal radiation therapy (SIRT) are unclear, and the available literature focuses on non-anatomical volumetric assessment techniques in a lobar treatment setting. This study aimed to investigate quantitative changes in the liver post-SIRT using an anatomical volumetric approach in hepatocellular carcinoma (HCC) patients with different levels of treatment selectivity and evaluate the parameters affecting those changes. This retrospective, single-institution, IRB-approved study included 88 HCC patients. Whole liver, liver segments, tumor burden, and spleen volumes were quantified on MRI at baseline and 3/6/12 months post-SIRT using a segmentation-based 3D software relying on liver vascular anatomy. Treatment characteristics, longitudinal clinical/laboratory, and imaging data were analyzed. The Student's t-test and Wilcoxon test evaluated volumetric parameters evolution. Spearman correlation was used to assess the association between variables. Uni/multivariate analyses investigated factors influencing untreated liver volume (uLV) increase. Results: Most patients were cirrhotic (92%) men (86%) with Child-Pugh A (84%). Absolute and relative uLV kept increasing at 3/6/12 months post-SIRT vs. baseline (all, p ≤ 0.005) and was maximal during the first 6 months. Absolute uLV increase was greater in Child-Pugh A5/A6 vs. ≥B7 at 3 months (A5, p = 0.004; A6, p = 0.007) and 6 months (A5, p = 0.072; A6, p = 0.031) vs. baseline. When the Child-Pugh class worsened at 3 or 6 months post-SIRT, uLV did not change significantly, whereas it increased at 3/6/12 months vs. baseline (all p ≤ 0.015) when liver function remained stable. The Child-Pugh score was inversely correlated with absolute and relative uLV increase at 3 months (rho = -0.21, p = 0.047; rho = -0.229, p = 0.048). In multivariate analysis, uLV increase was influenced at 3 months by younger age (p = 0.013), administered 90Y activity (p = 0.003), and baseline spleen volume (p = 0.023). At 6 months, uLV increase was impacted by younger age (p = 0.006), whereas treatment with glass microspheres (vs. resin) demonstrated a clear trend towards better hypertrophy (f = 3.833, p = 0.058). The amount (percentage) of treated liver strongly impacted the relative uLV increase at 3/6/12 months (all f ≥ 8.407, p ≤ 0.01). Conclusion: Liver function (preserved baseline and stable post-SIRT) favored uLV hypertrophy. Younger patients, smaller baseline spleen volume, higher administered 90Y activity, and a larger amount of treated liver were associated with a higher degree of untreated liver hypertrophy. These factors should be considered in surgical candidates undergoing neoadjuvant SIRT.
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Affiliation(s)
- Raphaël Girardet
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (R.G.); (J.-F.K.); (C.D.); (N.V.V.); (G.T.); (N.V.); (A.D.)
| | - Jean-François Knebel
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (R.G.); (J.-F.K.); (C.D.); (N.V.V.); (G.T.); (N.V.); (A.D.)
| | - Clarisse Dromain
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (R.G.); (J.-F.K.); (C.D.); (N.V.V.); (G.T.); (N.V.); (A.D.)
| | - Naik Vietti Violi
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (R.G.); (J.-F.K.); (C.D.); (N.V.V.); (G.T.); (N.V.); (A.D.)
| | - Georgia Tsoumakidou
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (R.G.); (J.-F.K.); (C.D.); (N.V.V.); (G.T.); (N.V.); (A.D.)
| | - Nicolas Villard
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (R.G.); (J.-F.K.); (C.D.); (N.V.V.); (G.T.); (N.V.); (A.D.)
| | - Alban Denys
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (R.G.); (J.-F.K.); (C.D.); (N.V.V.); (G.T.); (N.V.); (A.D.)
| | - Nermin Halkic
- Department of Visceral Surgery, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (N.H.); (N.D.); (K.K.)
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (N.H.); (N.D.); (K.K.)
| | - Kosuke Kobayashi
- Department of Visceral Surgery, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (N.H.); (N.D.); (K.K.)
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Antonia Digklia
- Department of Medical Oncology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland;
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (N.S.); (J.O.P.); (S.B.)
| | - John O. Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (N.S.); (J.O.P.); (S.B.)
| | - Sarah Boughdad
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (N.S.); (J.O.P.); (S.B.)
| | - Rafael Duran
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (R.G.); (J.-F.K.); (C.D.); (N.V.V.); (G.T.); (N.V.); (A.D.)
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Gravel G, Artru F, Gonzalez-Quevedo M, Tsoumakidou G, Villard N, Duran R, Denys A. Shunt dysfunction patterns after transjugular intrahepatic portosystemic shunt creation using a combination of a generic stent-graft and bare-stents. CVIR Endovasc 2024; 7:7. [PMID: 38198025 PMCID: PMC10781922 DOI: 10.1186/s42155-023-00421-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/15/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE Even though transjugular intrahepatic portosystemic shunt (TIPS) using Fluency Stent-grafts provides good shunt patency rates, shunt dysfunction is a great concern after TIPS creation, occurring in up to 20% of cases within one year. The objective of this study was to describe shunt dysfunction patterns after TIPS creation using a combination of generic stent-grafts/bare-stents. MATERIALS AND METHODS Single-center retrospective study of all TIPS revisions between January 2005 and December 2020. TIPS revision angiograms were analyzed for stents' positions, stenoses' diameters, and stenoses' locations. RESULTS Out of 99 TIPS, a total of 33 TIPS revisions were included. The median time to TIPS revision was 10.4 months. Angiograms showed four patterns of TIPS dysfunction-associated features (DAF), defined as follows: Type 1 was defined as stenosis located after the stent end in the hepatic vein (HV), type 2 as intra-stent stenosis located in the hepatic vein, type 3 as intra-stent stenosis or a kink in the parenchymal tract or the portal vein end of the TIPS, and type 4 as a complete TIPS occlusion. Types 1, 2, 3, and 4 were seen in 23 (69.7%), 5 (15.2%), 2 (6.1%), and 3 (9.1%) TIPS respectively. TIPS revision was successful in 30 (90.1%) patients with median pre- and post-TIPS revision PSG of 18.5 mmHg and 8 mmHg respectively (p < .001). CONCLUSION Our results illustrate the four angiographic patterns of TIPS DAF after TIPS creation using a combination of generic stent-grafts/bare-stents and emphasize the need for appropriate stent length extending to the HV/inferior vena cava junction.
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Affiliation(s)
- Guillaume Gravel
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Florent Artru
- Department of Liver Diseases, Rennes University Hospital, Rennes, France
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Miriam Gonzalez-Quevedo
- Department of Gastroenterology and Hepatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Georgia Tsoumakidou
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Villard
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rafael Duran
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alban Denys
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Tabotta F, Gnesin S, Dunet V, Ponti A, Digklia A, Boughdad S, Schaefer N, Prior JO, Villard N, Tsoumakidou G, Denys A, Duran R. 99mTc-macroaggregated albumin SPECT/CT predictive dosimetry and dose-response relationship in uveal melanoma liver metastases treated with first-line selective internal radiation therapy. Sci Rep 2023; 13:13118. [PMID: 37573346 PMCID: PMC10423257 DOI: 10.1038/s41598-023-39994-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
First-line selective internal radiation therapy (SIRT) showed promising outcomes in patients with uveal melanoma liver metastases (UMLM). Patient survival depends on liver's disease control. SIRT planning is essential and little is known about dosimetry. We investigated whether 99mTc-MAA-SPECT/CT dosimetry could predict absorbed doses (AD) evaluated on 90Y-PET/CT and assess the dose-response relationship in UMLM patients treated with first-line SIRT. This IRB-approved, single-center, retrospective analysis (prospectively collected cohort) included 12 patients (median age 63y, range 43-82). Patients underwent MRI/CT, 18F-FDG-PET/CT before and 3-6 months post-SIRT, and 90Y-PET/CT immediately post-SIRT. Thirty-two target lesions were included. AD estimates in tumor and non-tumor liver were obtained from 99mTc-MAA-SPECT/CT and post-SIRT 90Y-PET/CT, and assessed with Lin's concordance correlation coefficients (ρc and Cb), Pearson's coefficient correlation (ρ), and Bland-Altman analyses (mean difference ± standard deviation; 95% limits-of-agreement (LOA)). Influence of tumor characteristics and microsphere type on AD was analyzed. Tumor response was assessed according to size-based, enhancement-based and metabolic response criteria. Mean target lesion AD was 349 Gy (range 46-1586 Gy). Concordance between 99mTc-MAA-SPECT/CT and 90Y-PET/CT tumor dosimetry improved upon dose correction for the recovery coefficient (RC) (ρ = 0.725, ρc = 0.703, Cb = 0.969) with good agreement (mean difference: - 4.93 ± 218.3 Gy, 95%LOA: - 432.8-422.9). Without RC correction, concordance was better for resin microspheres (ρ = 0.85, ρc = 0.998, Cb = 0.849) and agreement was very good between predictive 99mTc-MAA-SPECT/CT and 90Y-PET/CT dosimetry (mean difference: - 4.05 ± 55.9 Gy; 95%LOA: - 113.7-105.6). After RC correction, 99mTc-MAA-SPECT/CT dosimetry overestimated AD (- 70.9 ± 158.9 Gy; 95%LOA: - 382.3-240.6). For glass microspheres, concordance markedly improved with RC correction (ρ = 0.790, ρc = 0.713, Cb = 0.903 vs without correction: ρ = 0.395, ρc = 0.244, Cb = 0.617) and 99mTc-MAA-SPECT/CT dosimetry underestimated AD (148.9 ± 267.5 Gy; 95%LOA: - 375.4-673.2). For non-tumor liver, concordance was good between 99mTc-MAA-SPECT/CT and 90Y-PET/CT dosimetry (ρ = 0.942, ρc = 0.852, Cb = 0.904). 99mTc-MAA-SPECT/CT slightly overestimated liver AD for resin (3.4 ± 3.4 Gy) and glass (11.5 ± 13.9 Gy) microspheres. Tumor AD was not correlated with baseline or post-SIRT lesion characteristics and no dose-response threshold could be identified. 99mTc-MAA-SPECT/CT dosimetry provides good estimates of AD to tumor and non-tumor liver in UMLM patients treated with first-line SIRT.
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Affiliation(s)
- Flavian Tabotta
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Ponti
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonia Digklia
- Department of Medical Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sarah Boughdad
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Villard
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Georgia Tsoumakidou
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alban Denys
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rafael Duran
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Vermersch M, Denys A, Artru F, Tsoumakidou G, Villard N, Duran R, Hocquelet A. Transhepatic tract hemostasis using thermal-ablation after percutaneous portal vein access. BJR Case Rep 2022; 8:20210080. [PMID: 35136636 PMCID: PMC8803226 DOI: 10.1259/bjrcr.20210080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/13/2021] [Accepted: 08/24/2021] [Indexed: 01/10/2023] Open
Abstract
Objectives: Bleeding risk after percutaneous portal vein access procedures is not negligible. Various agents, coils and plug, have been used to minimize this risk, each with their own advantages and disadvantages. This study reports the results of coagulation using thermal-ablation (radiofrequency or microwave ablation) as an alternative to trans-hepatic puncture tract closure. Methods: Ten patients who benefited from portal vein recanalization or portal hypertension-relative bleeding complication embolization using percutaneous portal vein access and who underwent thermal-ablation of the puncture tract between December 30, 2019 and July 16, 2020 were included. Early efficiency and safety were evaluated using imaging (ultrasound and/or CT scan) and laboratory data (hemoglobin, hepatic function) at 24 h. Follow-up was performed until August 2020. Results: No bleeding from the puncture tract and no embolization-related complications were observed in all 10 patients at 24 h or during follow-up with median of 3 months (range 1–8 months), even in case of ascites or therapeutic coagulation. Conclusion: Thermal-ablation seems to be a safe, effective and rapid technique to avoid bleeding after percutaneous transhepatic direct portal vein access. Advances in knowledge: Thermal-ablation could be an alternative for transhepatic puncture tract closure especially for patients with high bleeding risk.
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Affiliation(s)
- Mathilde Vermersch
- Department of Radiology, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Department or Radiology, Lille University Hospital, Lille, France
| | - Alban Denys
- Department of Radiology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Florent Artru
- Department of Gastro-enterology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Georgia Tsoumakidou
- Department of Radiology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Nicolas Villard
- Department of Radiology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Rafael Duran
- Department of Radiology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Arnaud Hocquelet
- Department of Radiology, Lausanne University Hospital CHUV, Lausanne, Switzerland
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Papadopoulos S, Koulouris P, Royer-Chardon C, Tsoumakidou G, Dolcan A, Cherix S, Matter M, Omoumi P, Digklia A. Case Report: Tyrosine Kinase Inhibitors Induced Lymphadenopathy in Desmoid Tumor Patients. Front Endocrinol (Lausanne) 2022; 13:794512. [PMID: 35399933 PMCID: PMC8984282 DOI: 10.3389/fendo.2022.794512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/26/2022] [Indexed: 11/21/2022] Open
Abstract
Tyrosine kinase inhibitors (TKIs) are nowadays a valuable treatment of desmoid tumors, a rare mesenchymal neoplasm. Although many side effects of imatinib and pazopanib, commonly or rarely occurring, have been described, reactional lymphadenopathy has not yet been reported. In this publication, we report two cases of patients with desmoid tumors, treated with pazopanib and imatinib, who developed reactional lymphadenopathy. As this side effect is presented as a newly formed mass, it can result in new diagnostic questions and added imaging tests and can even lead to discontinuation of the treatment. This report may help the clinicians facing similar problems adopt a "watch and wait" approach.
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Affiliation(s)
- Sotirios Papadopoulos
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- *Correspondence: Sotirios Papadopoulos,
| | - Pantelis Koulouris
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Claire Royer-Chardon
- Department of Pathology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Georgia Tsoumakidou
- Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Ana Dolcan
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Stephane Cherix
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Orthopaedics and Traumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Maurice Matter
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Antonia Digklia
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Tsoumakidou G, Saltiel S, Villard N, Duran R, Meuwly JY, Denys A. Image-guided marking techniques in interventional radiology: A review of current evidence. Diagn Interv Imaging 2021; 102:699-707. [PMID: 34419388 DOI: 10.1016/j.diii.2021.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 12/18/2022]
Abstract
Precise marking of lesions using image-guided techniques is essential, as imprecise targeting of a tumor can result in either insufficient excision/treatment with an increased risk of recurrence, or excessive removal of healthy tissue. Most frequent indications include localization of nonpalpable lesions before surgical resection (i.e., hook-wire localization of pulmonary nodules before video-assisted thoracoscopy) and definite marking of liver metastasis before neoadjuvant therapy. Other indications include marking of hepatocellular carcinomas that are not visible on ultrasound and unenhanced computed tomography before thermal ablation, of bone lesions before surgical excision, and of different visceral tumors before stereotactic radiotherapy. This review presents the different existing indications, assesses their usefulness, gives systematic details on the technique and lastly analyzes the current literature with emphasis on results and complications.
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Affiliation(s)
| | - Sarah Saltiel
- Department of Radiology, CHUV, CH-1011, Lausanne, Switzerland
| | - Nicolas Villard
- Department of Radiology, CHUV, CH-1011, Lausanne, Switzerland
| | - Rafael Duran
- Department of Radiology, CHUV, CH-1011, Lausanne, Switzerland
| | | | - Alban Denys
- Department of Radiology, CHUV, CH-1011, Lausanne, Switzerland
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Mahnken AH, Seoane EB, Cannavale A, de Haan MW, Dezman R, Kloeckner R, O'Sullivan G, Ryan A, Tsoumakidou G. Correction to: CIRSE Clinical Practice Manual. Cardiovasc Intervent Radiol 2021; 44:1498. [PMID: 34296339 DOI: 10.1007/s00270-021-02927-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Andreas H Mahnken
- Clinic of Diagnostic and Interventional Radiology, Marburg University Hospital, Baldingerstrasse, 35043, Marburg, Germany.
| | - Esther Boullosa Seoane
- Department of Vascular and Interventional Radiology, University Hospital of Vigo, Vigo, Spain
| | - Alessandro Cannavale
- Department of Radiological Sciences, 'Policlinico Umberto I'University Hospital, Rome, Italy
| | - Michiel W de Haan
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rok Dezman
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center, 55131, Mainz, Germany
| | | | - Anthony Ryan
- University Hospital Waterford and Royal College of Surgeons in Ireland, Waterford, Ireland
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Abstract
Background Interventional radiology (IR) has come a long way to a nowadays UEMS-CESMA endorsed clinical specialty. Over the last decades IR became an essential part of modern medicine, delivering minimally invasive patient-focused care. Purpose To provide principles for delivering high quality of care in IR. Methods Systematic description of clinical skills, principles of practice, organizational standards and infrastructure needed for the provision of professional IR services. Results There are IR procedures for almost all body parts and organs, covering a broad range of medical conditions. In many cases IR procedures are the mainstay of therapy, e.g. in the treatment of hepatocellular carcinoma. In parallel the specialty moved from the delivery of a procedure towards taking care for a patient’s condition with the interventional radiologists taking ultimate responsibility for the patient’s outcomes. Conclusions The evolution from a technical specialty to a clinical specialty goes along with changing demands on how clinical care in IR is provided. The CIRSE Clinical Practice Manual provides interventional radiologist with a starting point for developing his or her IR practice as a clinician.
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Affiliation(s)
- Andreas H. Mahnken
- Clinic of Diagnostic and Interventional Radiology, Marburg University Hospital, Baldingerstrasse, 35043 Marburg, Germany
| | - Esther Boullosa Seoane
- Department of Vascular and Interventional Radiology, University Hospital of Vigo, Vigo, Spain
| | - Allesandro Cannavale
- Department of Radiological Sciences, ‘Policlinico Umberto I’University Hospital, Rome, Italy
| | - Michiel W. de Haan
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rok Dezman
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center, 55131 Mainz, Germany
| | | | - Anthony Ryan
- University Hospital Waterford and Royal College of Surgeons in Ireland, Waterford, Ireland
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Girardet R, Boughdad S, Digklia A, Beigelman C, Meyer M, Schaefer N, Vermersch M, Hocquelet A, Tsoumakidou G, Denys A, Duran R. Transarterial Radioembolization for the Treatment of Advanced Hepatocellular Carcinoma Invading the Right Atrium. Cardiovasc Intervent Radiol 2020; 43:1712-1715. [PMID: 32761249 PMCID: PMC7591430 DOI: 10.1007/s00270-020-02605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
Hepatocellular carcinoma (HCC) has the tendency to invade the portal and/or hepatic venous system. The invasion of the right atrium is uncommonly observed and constitutes a treatment challenge. We report the case of a patient with HCC invading the right atrium treated with 90Yttrium-transarterial radioembolization (90Y-TARE). Following the treatment, organizing pneumonia secondary to nivolumab occurred, raising the question of an interaction between 90Y-TARE and nivolumab.
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Affiliation(s)
- Raphaël Girardet
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sarah Boughdad
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Antonia Digklia
- Department of Medical Oncology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Catherine Beigelman
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Marie Meyer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Mathilde Vermersch
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Arnaud Hocquelet
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Georgia Tsoumakidou
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Alban Denys
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Rafael Duran
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Volpi S, Tsoumakidou G, Loriaud A, Hocquelet A, Duran R, Denys A. Electromagnetic navigation system combined with High-Frequency-Jet-Ventilation for CT-guided hepatic ablation of small US-Undetectable and difficult to access lesions. Int J Hyperthermia 2019; 36:1051-1057. [DOI: 10.1080/02656736.2019.1671612] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Stephanie Volpi
- Department of Radiology, Centre Hospitalo-Universitaire Vaudois, Interventional Radiology Unit, Lausanne, Switzerland
- Department of Radiology, Institut de Cancerologie de l’Ouest-René Gauducheau, Saint Herblain Cedex, France
| | - Georgia Tsoumakidou
- Department of Radiology, Centre Hospitalo-Universitaire Vaudois, Interventional Radiology Unit, Lausanne, Switzerland
| | - Amélie Loriaud
- Department of Radiology, Centre Hospitalo-Universitaire Vaudois, Interventional Radiology Unit, Lausanne, Switzerland
| | - Arnaud Hocquelet
- Department of Radiology, Centre Hospitalo-Universitaire Vaudois, Interventional Radiology Unit, Lausanne, Switzerland
| | - Rafael Duran
- Department of Radiology, Centre Hospitalo-Universitaire Vaudois, Interventional Radiology Unit, Lausanne, Switzerland
| | - Alban Denys
- Department of Radiology, Centre Hospitalo-Universitaire Vaudois, Interventional Radiology Unit, Lausanne, Switzerland
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Tsoumakidou G, Mandralis K, Hocquelet A, Duran R, Denys A. Salvage Lymph-Node Percutaneous Cryoablation: Safety Profile and Oncologic Outcomes. Cardiovasc Intervent Radiol 2019; 43:264-272. [DOI: 10.1007/s00270-019-02341-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/06/2019] [Indexed: 12/14/2022]
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Rao PP, Breton E, Garnon J, Cazzato RL, Koch G, Caudrelier J, Tsoumakidou G, Gangi A. Preclinical evaluation of the atraumatic nature of a spring loaded blunt tip coaxial needle in a swine model. Diagn Interv Imaging 2019; 100:813-820. [PMID: 31378512 DOI: 10.1016/j.diii.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/19/2019] [Accepted: 07/03/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To test in vivo in an animal model the inherent atraumatic characteristics of the spring loaded blunt tip of a coaxial needle (Gangi-SoftGuard®, Apriomed, Sweden) against a conventional sharp stylet coaxial needle. MATERIAL AND METHODS The study was conducted on a 40kg male swine that was its own control for a vascular trauma model. The procedure consisted of voluntary attempts to transfix and traverse the artery/aorta under continuous real-time angiogram. Test and control needles were positioned in the region of the intercostal, superior mesenteric and femoral/deep femoral arteries, and in the aorta. Computed tomography (CT) angiogram was performed post trauma to check for bleeding in the form of extravasation of contrast material. One attempt was performed per site and needle, except for the intercostal artery where a second attempt was done with the test needle, resulting in a total of 4 and 5 tests for the control and test needles, respectively. RESULTS With the spring loaded blunt tip, no vascular trauma or bleeding was noted in the intercostal, superior mesenteric and femoral arteries, nor in the aorta. Vascular spasm that recovered with time was noted during the second attempt to transfix the same intercostal artery. There were consistent vascular traumas and bleedings with the control needle in all three tested arteries and the aorta, confirmed on angiogram as well as CT angiogram. CONCLUSION The atraumatic feature offered by the spring loaded blunt tip prevented vascular trauma during the 5 attempts made to transfix the artery/aorta in a swine.
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Affiliation(s)
- P P Rao
- ICube UMR7357, CNRS, université de Strasbourg, 67091 Strasbourg, France; Department of Interventional Radiology, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France; Department of Radiology, hôpitaux civils de Colmar, 68000 Colmar, France.
| | - E Breton
- ICube UMR7357, CNRS, université de Strasbourg, 67091 Strasbourg, France
| | - J Garnon
- ICube UMR7357, CNRS, université de Strasbourg, 67091 Strasbourg, France; Department of Interventional Radiology, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - R L Cazzato
- ICube UMR7357, CNRS, université de Strasbourg, 67091 Strasbourg, France; Department of Interventional Radiology, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - G Koch
- Department of Interventional Radiology, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - J Caudrelier
- Department of Interventional Radiology, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - G Tsoumakidou
- Department of Interventional Radiology, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - A Gangi
- ICube UMR7357, CNRS, université de Strasbourg, 67091 Strasbourg, France; Department of Interventional Radiology, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
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13
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De Marini P, Cazzato RL, Garnon J, Tricard T, Koch G, Tsoumakidou G, Ramamurthy N, Lang H, Gangi A. Percutaneous MR-guided whole-gland prostate cancer cryoablation: safety considerations and oncologic results in 30 consecutive patients. Br J Radiol 2019; 92:20180965. [PMID: 30845821 DOI: 10.1259/bjr.20180965] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the safety and oncological efficacy of percutaneous MR-guided whole-gland prostate cancer (PCa) cryoablation (CA). METHODS AND MATERIALS Between July 2009 and January 2018, 30 patients (mean age 72.9 ± 5.13 years) with histologically proven, organ-confined (≤ T2cN0M0), predominantly low/intermediate-risk PCa (median Gleason score 7; mean prostate specific antigen 6.05 ± 3.74 ng ml-1 ) underwent MR-guided whole-gland CA. Patients were selected on the basis of prior pelvic radiotherapy (n = 16; 12 for previous PCa), or contra indication/refusal of surgery or radiotherapy. Complications, local progression-free survival (LPFS) and overall survival (OS) were retrospectively investigated. RESULTS Eighteen [60%] patients reported procedure-related complications: 5/18 [28%] needed surgical/interventional treatments and 13 [72%] conservative or pharmacological treatment. Eleven [73%] complications were noted in the first 15 patients and 7 [47%] in the last 15 patients (p = 0.26). Mean nadir prostate specific antigen was 0.24 ± 1.5 ng ml-1 (mean follow-up 3.8 years; range: 2 - 2915 days). Seven [23%] patients developed histologically proven local progression (mean time to recurrence 775 days, range: 172 - 2014). Mean clinical follow-up was 3.8 years (range 1-2915 days). LPFS was 92.0, 75.7 and 69.4 % at 1-, 3- and 5 year follow-up, respectively. For patients in salvage treatment, LPFS was 100%, 75%, and 75% at 1-, 3- and 5 year follow-up. OS was 100%, 94.4 and 88.5 % at 1-, 3- and 5 year follow-up respectively, with no patients dying from PCa. CONCLUSION Whole-gland PCa CA offers good oncological efficacy, particularly in post-radiotherapy cases. Although the complication rate is significant, the majority is minor and is managed with conservative or pharmacologic management. ADVANCES IN KNOWLEDGE MRI-guided whole-gland prostate cancer cryoablation offers good oncological efficacy, particularly in post-radiotherapy cases with a contained complication rate.
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Affiliation(s)
- Pierre De Marini
- 1 Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France
| | - Roberto Luigi Cazzato
- 1 Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France
| | - Julien Garnon
- 1 Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France
| | - Thibault Tricard
- 2 Department of Urology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France
| | - Guillaume Koch
- 1 Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France
| | - Georgia Tsoumakidou
- 1 Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France.,3 Department of Interventional Radiology, University Hospital of Lausanne , Switzerland
| | - Nitin Ramamurthy
- 4 Department of Radiology, Norfolk and Norwich University Hospital , Norwich , UK
| | - Hervé Lang
- 2 Department of Urology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France
| | - Afshin Gangi
- 1 Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France
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Tricard T, Garnon J, Tsoumakidou G, Mouracadé P, Caudrelier J, De Mathelin M, Gangi A, Lang H. Cancer de prostate : « tout IRM » du diagnostic au traitement focal « vrai » ? Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Cazzato RL, Garnon J, Koch G, Shaygi B, Tsoumakidou G, Caudrelier J, Boatta E, Buy X, Palussiere J, Gangi A. Current role of interventional radiology in the management of visceral and bone metastases from thyroid cancer. Gland Surg 2018; 7:80-88. [PMID: 29770304 DOI: 10.21037/gs.2017.12.08] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The metastatic disease from thyroid cancer represents a complex clinical scenario, which mandates a case-based multi-disciplinary approach in tertiary referral centers. Direct localised treatments such as minimally invasive interventional radiology procedures can play a vital role in providing a timely palliative or curative treatment in accordance with the patients' clinical status. In this narrative review, we present the current status of interventional radiology treatments for the management of thyroid cancer distant metastases.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Behnam Shaygi
- Department of Interventional Radiology, Royal Devon and Exeter Hospital, NHS Trust, Exeter, UK
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Emanuele Boatta
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Xavier Buy
- Department of Interventional Radiology, Institut Bergonié, Bordeaux, France
| | - Jean Palussiere
- Department of Interventional Radiology, Institut Bergonié, Bordeaux, France
| | - Afshin Gangi
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
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Abstract
In the last decade, the spectrum of interventional magnetic resonance imaging (MRI)-guided procedures, including percutaneous ablation, has substantially grown, and among the available MRI-compatible ablative techniques, cryoablation is progressively gaining a predominant position.The aim of the present narrative review is to discuss the technical requirements necessary to perform a percutaneous MRI-guided cryoablation in a closed-bore machine; to highlight the relative advantages and drawbacks; and to briefly summarize the results available in the literature.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Behnam Shaygi
- Interventional Radiology Department, Royal Devon and Exeter Hospital NHS Trust, Exeter, UK
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
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Koch G, Garnon J, Tsoumakidou G, Edalat F, Caudrelier J, Cazzato RL, Gangi A. Adrenal Biopsy under Wide-Bore MR Imaging Guidance. J Vasc Interv Radiol 2018; 29:285-290. [DOI: 10.1016/j.jvir.2017.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/02/2017] [Accepted: 04/24/2017] [Indexed: 01/20/2023] Open
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18
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Garnon J, Cazzato RL, Koch G, Uri IF, Tsoumakidou G, Caudrelier J, Tricard T, Gangi A, Lang H. Trans-rectal Ultrasound-Guided Autologous Blood Injection in the Interprostatorectal Space Prior to Percutaneous MRI-Guided Cryoablation of the Prostate. Cardiovasc Intervent Radiol 2017; 41:653-659. [PMID: 29230498 DOI: 10.1007/s00270-017-1853-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report a novel technique of ultrasound-guided injection of autologous blood in the interprostatorectal space, in an attempt to facilitate ablative prostatic procedures by widening durably the space between the rectum and the prostate. MATERIALS AND METHODS Between April and November 2016, four consecutive patients underwent the haemoprotection injection technique. For each patient, we recorded the time to perform the technique, the amount of injected blood, the achieved distances between the rectum and the prostate post-injection at fixed defined points (apex, middle, and base of prostate at the midline, left, and right sides of the gland), the extension of the ice ball outside the prostate capsule at those fixed points, and whether any residual blood was present on 1-month follow-up MRI. RESULTS Mean time to perform haemoprotection injection was 54 min, with an average blood volume of 103 cc. Mean distance achieved at the apex, middle, and base of the prostate, respectively, was 12, 13, and 16 mm in the midline; 8, 10, and 13 mm on the left side; and 9, 10, and 13 mm on the right side. The mean extension distance of the ice ball beyond the capsule was 4, 6, and 6 mm in the midline; 4, 5, and 6 mm on the left side; and 1, 3, and 3 mm on the right side. No residual blood was present on 1-month follow-up MRI in all patients. No rectal fistula occurred. CONCLUSION Haemoprotection may create a safe and effective virtual space between the prostate and rectum.
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Affiliation(s)
- Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France.
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Ishaq Fahmi Uri
- Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Thibault Tricard
- Department of Urology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Hervé Lang
- Department of Urology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
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Cazzato RL, Garnon J, Shaygi B, Koch G, Tsoumakidou G, Caudrelier J, Addeo P, Bachellier P, Namer IJ, Gangi A. PET/CT-guided interventions: Indications, advantages, disadvantages and the state of the art. MINIM INVASIV THER 2017; 27:27-32. [DOI: 10.1080/13645706.2017.1399280] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), Strasbourg, France
| | - Behnam Shaygi
- Interventional Radiology Department, Royal Devon and Exeter Hospital, NHS Trust, Exeter, UK
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), Strasbourg, France
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), Strasbourg, France
| | - Pietro Addeo
- Department of Hepatic, Biliary and Pancreatic Surgery and Liver Transplantation, Hôpital de Hautepierre (Hopitaux Universitaires de Strasbourg, HUS), Strasbourg, France
| | - Philippe Bachellier
- Department of Hepatic, Biliary and Pancreatic Surgery and Liver Transplantation, Hôpital de Hautepierre (Hopitaux Universitaires de Strasbourg, HUS), Strasbourg, France
| | - Izzie Jacques Namer
- Department of Biophysics and Nuclear Medicine, Hôpital de Hautepierre (Hôpitaux Universitaires de Strasbourg, HUS), Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), Strasbourg, France
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Tricard T, Tsoumakidou G, Lindner V, Garnon J, Albrand G, Cathelineau X, Gangi A, Lang H. Thérapies ablatives dans le cancer du rein : indications. Prog Urol 2017; 27:926-951. [DOI: 10.1016/j.purol.2017.07.245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/22/2017] [Indexed: 12/19/2022]
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Hebbadj S, Cazzato RL, Garnon J, Shaygi B, Buy X, Tsoumakidou G, Lang H, Gangi A. Safety Considerations and Local Tumor Control Following Percutaneous Image-Guided Cryoablation of T1b Renal Tumors. Cardiovasc Intervent Radiol 2017; 41:449-458. [DOI: 10.1007/s00270-017-1820-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/12/2017] [Indexed: 12/19/2022]
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Garnon J, Koch G, Tsoumakidou G, Caudrelier J, Chari B, Cazzato RL, Gangi A. Ultrasound-Guided Biopsies of Bone Lesions Without Cortical Disruption Using Fusion Imaging and Needle Tracking: Proof of Concept. Cardiovasc Intervent Radiol 2017; 40:1267-1273. [PMID: 28357575 DOI: 10.1007/s00270-017-1638-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/22/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To assess the technical feasibility and safety of combined fusion imaging and needle tracking under ultrasound guidance to target bone lesions without cortical disruption. MATERIALS AND METHODS Between January 2016 and March 2016, seven patients underwent US-guided biopsy of bone lesions without cortical disruption. Targeted bone lesions were measuring more than 1.5 cm with a thin cortex, a trans-osseous pathway not exceeding 2 cm and without any adjacent vulnerable structures. First three procedures were performed in the CT suite to aid the needle tracking where necessary (group 1), the remaining four procedures were performed in the US suite (group 2). In group 1, deviation from the real position of the bone trocar (estimated on CT) was compared to the virtual position (estimated on the fusion CT-US images). In both group, procedure data and histopathological results were collected, and compared to the suspected diagnosis and follow-up. RESULTS Mean procedure duration was 44 min. Total number of synchronisation points for combined fusion imaging were 3.3 on average. In group 1, mean deviation between the virtual and real CT coordinates was 5.3 mm on average. All biopsies yielded adequate quality analysable bone sample. Histopathological analysis revealed malignancy in three cases, non-specific inflammation in two cases, and normal bone in two cases. The four benign results were confirmed as true negative results. There were no immediate or post-procedural complications. CONCLUSION The use of combined fusion imaging and needle tracking ultrasound guidance to target bone lesions without cortical disruption seems technically feasible, provided the patient and lesion selection is appropriate.
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Affiliation(s)
- Julien Garnon
- Department of Interventional Radiology, Hopitaux universitaires de Strasbourg, 1, Place de l'Hopital, 67096, Strasbourg Cedex, France.
| | - Guillaume Koch
- Department of Interventional Radiology, Hopitaux universitaires de Strasbourg, 1, Place de l'Hopital, 67096, Strasbourg Cedex, France
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Hopitaux universitaires de Strasbourg, 1, Place de l'Hopital, 67096, Strasbourg Cedex, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Hopitaux universitaires de Strasbourg, 1, Place de l'Hopital, 67096, Strasbourg Cedex, France
| | - Basavaraj Chari
- Oxford University Hospitals, Nuffield Orthopaedic Centre, Oxford, UK
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, Hopitaux universitaires de Strasbourg, 1, Place de l'Hopital, 67096, Strasbourg Cedex, France
| | - Afshin Gangi
- Department of Interventional Radiology, Hopitaux universitaires de Strasbourg, 1, Place de l'Hopital, 67096, Strasbourg Cedex, France
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Garnon J, Koch G, Ramamurthy N, Bauones S, Caudrelier J, Tsoumakidou G, Cazzato RL, Gangi A. Percutaneous Imaging-Guided Screw Fixation of Osteoporotic Transverse Fractures of the Lower Sacrum with Cement Augmentation: Report of 2 Cases. Cardiovasc Intervent Radiol 2017; 40:1105-1111. [PMID: 28357574 DOI: 10.1007/s00270-017-1633-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 03/21/2017] [Indexed: 12/24/2022]
Abstract
Osteoporotic fractures of the sacrum usually involve the sacral ala and can be managed with percutaneous cementoplasty if conservative therapy failed to achieve bone consolidation. On the other hand, isolated transverse fractures of the lowest sacrum are more rare, with little literature focusing on their management in the osteoporotic population. If pseudoarthrosis occurs in this location, sacroplasty is not an optimal therapeutic option because of the poor biomechanical resistance of cement to multi-directional stresses. Hence, we report two cases of chronic unhealed transverse fractures of the lowest sacrum successfully managed with percutaneous image-guided screw fixation augmented with cement injection. At last follow-up available, both patients experienced complete pain relief, without evidences of failure of the osteosynthesis on CT-scan controls.
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Affiliation(s)
- Julien Garnon
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg, Place de l'Hopital, 67096, Strasbourg, France.
| | - Guillaume Koch
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg, Place de l'Hopital, 67096, Strasbourg, France
| | - Nitin Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Salem Bauones
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg, Place de l'Hopital, 67096, Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg, Place de l'Hopital, 67096, Strasbourg, France
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg, Place de l'Hopital, 67096, Strasbourg, France
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg, Place de l'Hopital, 67096, Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg, Place de l'Hopital, 67096, Strasbourg, France
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Cazzato RL, Garnon J, Tsoumakidou G, Koch G, Palussière J, Gangi A, Buy X. Percutaneous image-guided screws meditated osteosynthesis of impeding and pathological/insufficiency fractures of the femoral neck in non-surgical cancer patients. Eur J Radiol 2017; 90:1-5. [PMID: 28583620 DOI: 10.1016/j.ejrad.2017.02.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/02/2017] [Accepted: 02/15/2017] [Indexed: 11/28/2022]
Abstract
AIM To present percutaneous image-guided screw-mediated osteosynthesis (PIGSMO) for fixation of impending fractures (ImF) and non-displaced/mildly displaced pathological/insufficient fractures (PF/InF) of the femoral neck in non-surgical cancer patients. MATERIALS AND METHODS This is a double-centre single-arm observational study. Retrospective review of electronic records identified all oncologic patients who had undergone femoral neck PIGSMO. Inclusion criteria were: non-displaced or mildly displaced PF/InF, and ImF (Mirels' score ≥8); life expectancy ≥1 month; unsuitability for surgical treatment due to sub-optimal clinical fitness, refusal of consent, or unacceptable delay to systemic therapy. RESULTS Eleven patients were treated (mean age 63.7±13.5 years) due to ImF (63.6%, mean Mirels' score 10.1), PF (27.3%) or post-radiation InF (9.1%) under CT/fluoroscopy- (36.4%) or CBCT- (63.6%) guidance. Thirty-two screws were implanted and cement injection was added in 36.4% cases. Technical success was 90.9%. No procedure related complications were noted. At 1-month clinical follow-up (pain/walking impairment), 63.6% and 27.3% patients reported significant and mild improvement, respectively. Imaging follow-up (available in 63.6% cases) showed no signs of secondary fractures, neither of screws loosening at mean 2.8 months. Five patients (45.5%) died after PIGSMO (mean time interval 3.6 months). CONCLUSIONS PIGSMO is technically feasible and safe in cancer patients with limited life expectancy; it offers good short-term results. Further prospective studies are required to corroborate mid- and to prove long-term efficacy of the technique.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), 1, place de l'Hopital, 67000 Strasbourg, France.
| | - Julien Garnon
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), 1, place de l'Hopital, 67000 Strasbourg, France.
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), 1, place de l'Hopital, 67000 Strasbourg, France.
| | - Guillaume Koch
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), 1, place de l'Hopital, 67000 Strasbourg, France.
| | - Jean Palussière
- Department of Radiology, Institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France.
| | - Afshin Gangi
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), 1, place de l'Hopital, 67000 Strasbourg, France.
| | - Xavier Buy
- Department of Radiology, Institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France.
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Edalat F, Cazzato RL, Garnon J, Tsoumakidou G, Avérous G, Caudrelier J, Koch G, Gangi A. Percutaneous Biopsy of Retrobulbar Masses: Anatomical Considerations and MRI Guidance. Cardiovasc Intervent Radiol 2016; 40:591-595. [DOI: 10.1007/s00270-016-1523-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
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Cazzato RL, Garnon J, Ramamurthy N, Koch G, Tsoumakidou G, Caudrelier J, Arrigoni F, Zugaro L, Barile A, Masciocchi C, Gangi A. Percutaneous image-guided cryoablation: current applications and results in the oncologic field. Med Oncol 2016; 33:140. [PMID: 27837451 DOI: 10.1007/s12032-016-0848-3] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/22/2016] [Indexed: 12/12/2022]
Abstract
Percutaneous imaging-guided cryoablation (PICA) is a recently developed technique, which applies extreme hypothermia to destroy tumours under close imaging surveillance. It is minimally invasive, safe, repeatable, and does not interrupt or compromise other oncologic therapies. It presents several advantages over more established heat-based thermal ablation techniques (e.g. radiofrequency ablation; RFA) including intrinsic analgesic properties, superior monitoring capability on multi-modal imaging, ability to treat larger tumours, and preservation of tissue collagenous architecture. There has been a recent large increase in reports evaluating the utility of PICA in a wide range of patients and tumours, but systematic analysis of the literature is challenging due to the rapid pace of change and predominance of extensively heterogeneous level III studies. The precise onco-therapeutic role of PICA has not been established. This narrative review outlines the available evidence for PICA in a range of tumours. Current indications include curative therapy of small T1a renal tumours; curative/palliative therapy of small primary/secondary lung tumours where RFA is unsuitable; palliation of painful bone metastases; and urologic treatment of organ-confined prostate cancer. There is growing evidence to support its use for small hepatic tumours, and encouraging results have been obtained for breast tumours, extra-abdominal desmoid tumours, and management of higher-stage tumours and oligometastatic disease. However, the overall evidence base is weak, effectively restricting PICA to cases where standard therapy and RFA are unsuitable. As the technique and evidence continue to mature, the benefits of this emerging technique will hopefully become more widely available to cancer patients in the future.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France.
| | - Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Nitin Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Francesco Arrigoni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luigi Zugaro
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
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Cazzato RL, Garnon J, Ramamurthy N, Tsoumakidou G, Thenint MA, Koch G, Gangi A. Transdiscal Hydrodissection of the Retrocrural Space to Optimize Percutaneous Image-Guided Cryoablation of a Nodal Metastasis: Case Report of a Novel Technique. J Vasc Interv Radiol 2016; 27:1463-1464. [DOI: 10.1016/j.jvir.2016.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/22/2016] [Accepted: 05/22/2016] [Indexed: 10/21/2022] Open
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Garnon J, Cazzato RL, Ramamurthy N, Tsoumakidou G, Bauones S, Caudrelier J, Koch G, Gangi A. Curved Needles: Beyond Diagnostic Procedures. Cardiovasc Intervent Radiol 2016; 39:1521-4. [DOI: 10.1007/s00270-016-1397-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/10/2016] [Indexed: 11/24/2022]
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Garnon J, Koch G, Caudrelier J, Ramamurthy N, Rao P, Tsoumakidou G, Cazzato RL, Gangi A. Percutaneous Image-Guided Cryoablation of Challenging Mediastinal Lesions Using Large-Volume Hydrodissection: Technical Considerations and Outcomes. Cardiovasc Intervent Radiol 2016; 39:1636-1643. [DOI: 10.1007/s00270-016-1396-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/26/2016] [Indexed: 12/26/2022]
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Cazzato RL, Koch G, Buy X, Ramamurthy N, Tsoumakidou G, Caudrelier J, Catena V, Garnon J, Palussiere J, Gangi A. Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus. Cardiovasc Intervent Radiol 2016; 39:1455-63. [DOI: 10.1007/s00270-016-1389-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
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Cazzato RL, Garnon J, Ramamurthy N, Tsoumakidou G, Caudrelier J, Thenint MA, Rao P, Koch G, Gangi A. Percutaneous MR-Guided Cryoablation of Morton’s Neuroma: Rationale and Technical Details After the First 20 Patients. Cardiovasc Intervent Radiol 2016; 39:1491-8. [DOI: 10.1007/s00270-016-1365-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/09/2016] [Indexed: 02/07/2023]
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Cazzato RL, Garnon J, Ramamurthy N, Tsoumakidou G, Imperiale A, Namer IJ, Bachellier P, Caudrelier J, Rao P, Koch G, Gangi A. 18F-FDOPA PET/CT-Guided Radiofrequency Ablation of Liver Metastases from Neuroendocrine Tumours: Technical Note on a Preliminary Experience. Cardiovasc Intervent Radiol 2016; 39:1315-21. [PMID: 27048487 DOI: 10.1007/s00270-016-1334-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 03/26/2016] [Indexed: 12/20/2022]
Abstract
AIM To review our preliminary experience with 6-L-18F-fluorodihydroxyphenylalanine (18F-FDOPA) PET/CT-guided radiofrequency ablation (RFA) of liver metastases from neuroendocrine tumours (NETs). MATERIALS AND METHODS Three patients (mean age 51.3 years; range 43-56) with gastro-entero pancreatic NET (GEP-NET) liver metastases underwent 18F-FDOPA PET/CT-guided RFA. Patients were referred with oligometastatic hepatic-confined disease (1-6 metastases; <3 cm) on 18F-FDOPA PET/CT; poor lesion visualisation on US, CT, and MR; and ongoing symptoms. Procedures were performed in an interventional PET/CT scanner under general anaesthesia using a split-dose protocol. Lesion characteristics, procedural duration and technical success (accurate probe placement and post-procedural ablation-zone photopaenia), complications, patient and operator dose, and clinical outcomes were evaluated. RESULTS Thirteen liver metastases (mean size 11.4 mm, range 8-16) were treated in three patients (two presented with "carcinoid syndrome"). Technical success was 100 % with a mean procedural duration of 173.3 min (range 90-210) and no immediate complications. Mean patient dose was 2844 mGy·cm (range 2104-3686). Operator and radiographer doses were acceptable other than the operator's right hand in the first case (149 µSv); this normalised in the second case. There was no local tumour or extra-hepatic disease progression at mid-term follow-up (mean 12.6 months; range 6-20); however, two cases progressed with new liver metastases at different sites. There was 100 % clinical success (n = 2) in resolving carcinoid syndrome symptoms. CONCLUSION 18F-FDOPA PET/CT-guided RFA appears technically feasible, safe, and effective in patients with GEP-NETs and low-burden hepatic metastases. Further prospective studies are required to elucidate its precise role in tailored multimodality management of GEP-NET liver metastases.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), 1, place de l'Hôpital, 67000, Strasbourg, France.
| | - Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), 1, place de l'Hôpital, 67000, Strasbourg, France
| | - Nitin Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), 1, place de l'Hôpital, 67000, Strasbourg, France
| | - Alessio Imperiale
- Department of Biophysics and Nuclear Medicine, Hôpital de Hautepierre (Hôpitaux Universitaires de Strasbourg, HUS), Avenue Molière, 67200, Strasbourg, France
| | - Izzie Jacques Namer
- Department of Biophysics and Nuclear Medicine, Hôpital de Hautepierre (Hôpitaux Universitaires de Strasbourg, HUS), Avenue Molière, 67200, Strasbourg, France
| | - Philippe Bachellier
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Hôpital de Hautepierre (Hôpitaux Universitaires de Strasbourg, HUS), Avenue Molière, 67200, Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), 1, place de l'Hôpital, 67000, Strasbourg, France
| | - Pramod Rao
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), 1, place de l'Hôpital, 67000, Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), 1, place de l'Hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), 1, place de l'Hôpital, 67000, Strasbourg, France
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Garnon J, Koch G, Ramamurthy N, Caudrelier J, Rao P, Tsoumakidou G, Cazzato RL, Gangi A. A Pitfall of Cryoadhesional Displacement During Cryoablation of Lung Metastasis to Require Modification of Triple-Freeze Protocol. Cardiovasc Intervent Radiol 2016; 39:960-4. [PMID: 26908364 DOI: 10.1007/s00270-016-1312-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 02/14/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France.
| | - Guillaume Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Nitin Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Jean Caudrelier
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Pramod Rao
- ICube, University of Strasbourg, Strasbourg, France
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
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Cazzato RL, Garnon J, Ramamurthy N, Tsoumakidou G, Caudrelier J, Thénint MA, Rao P, Koch G, Gangi A. Percutaneous Management of Accidentally Retained Foreign Bodies During Image-Guided Non-vascular Procedures: Novel Technique Using a Large-Bore Biopsy System. Cardiovasc Intervent Radiol 2016; 39:1050-6. [DOI: 10.1007/s00270-016-1302-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/05/2016] [Indexed: 11/24/2022]
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Garnon J, Koch G, Rao P, Ramamurthy N, Caudrelier J, Cazzato RL, Tsoumakidou G, Gangi A. Optimising Pulmonary Microwave Ablation Using Trans-Scapular Access and Continuous Temperature Monitoring. Cardiovasc Intervent Radiol 2016; 39:791-794. [PMID: 26817761 DOI: 10.1007/s00270-016-1298-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/10/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, France, 1, place de l'hôpital, 67000, Strasbourg, France.
| | - Guillaume Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, France, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Pramod Rao
- ICube, University of Strasbourg, France, 300 bd Sébastien Brant, 67412, Illkirch, France
| | - Nitin Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Colney Ln, Norwich, NR4 7UY, UK
| | - Jean Caudrelier
- Department of Interventional Radiology, University Hospital of Strasbourg, France, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, France, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, University Hospital of Strasbourg, France, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, France, 1, place de l'hôpital, 67000, Strasbourg, France
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Garnon J, Ramamurthy N, Caudrelier J J, Erceg G, Breton E, Tsoumakidou G, Rao P, Gangi A. MRI-Guided Percutaneous Biopsy of Mediastinal Masses Using a Large Bore Magnet: Technical Feasibility. Cardiovasc Intervent Radiol 2015; 39:761-767. [PMID: 26604114 DOI: 10.1007/s00270-015-1246-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 09/11/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy and safety of magnetic resonance imaging (MRI)-guided percutaneous biopsy of mediastinal masses performed using a wide-bore high-field scanner. MATERIALS AND METHODS This is a retrospective study of 16 consecutive patients (8 male, 8 female; mean age 74 years) who underwent MRI-guided core needle biopsy of a mediastinal mass between February 2010 and January 2014. Size and location of lesion, approach taken, time for needle placement, overall duration of procedure, and post-procedural complications were evaluated. Technical success rates and correlation with surgical pathology (where available) were assessed. RESULTS Target lesions were located in the anterior (n = 13), middle (n = 2), and posterior mediastinum (n = 1), respectively. Mean size was 7.2 cm (range 3.6-11 cm). Average time for needle placement was 9.4 min (range 3-18 min); average duration of entire procedure was 42 min (range 27-62 min). 2-5 core samples were obtained from each lesion (mean 2.6). Technical success rate was 100%, with specimens successfully obtained in all 16 patients. There were no immediate complications. Histopathology revealed malignancy in 12 cases (4 of which were surgically confirmed), benign lesions in 3 cases (1 of which was false negative following surgical resection), and one inconclusive specimen (treated as inaccurate since repeat CT-guided biopsy demonstrated thymic hyperplasia). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in our study were 92.3, 100, 100, 66.7, and 87.5%, respectively. CONCLUSION MRI-guided mediastinal biopsy is a safe procedure with high diagnostic accuracy, which may offer a non-ionizing alternative to CT guidance.
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Affiliation(s)
- J Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil, Strasbourg, France.
| | - N Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - J Caudrelier J
- Department of Interventional Radiology, Nouvel Hôpital Civil, Strasbourg, France
| | - G Erceg
- ICube, University of Strasbourg, CNRS, Strasbourg, France
| | - E Breton
- ICube, University of Strasbourg, CNRS, Strasbourg, France
| | - G Tsoumakidou
- Department of Interventional Radiology, Nouvel Hôpital Civil, Strasbourg, France
| | - P Rao
- Department of Interventional Radiology, Nouvel Hôpital Civil, Strasbourg, France.,ICube, University of Strasbourg, CNRS, Strasbourg, France
| | - A Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil, Strasbourg, France.,ICube, University of Strasbourg, CNRS, Strasbourg, France
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Tsoumakidou G, Thénint MA, Garnon J, Buy X, Steib JP, Gangi A. Percutaneous Image-guided Laser Photocoagulation of Spinal Osteoid Osteoma: A Single-Institution Series. Radiology 2015; 278:936-43. [PMID: 26383230 DOI: 10.1148/radiol.2015150491] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To retrospectively evaluate the safety and efficacy of percutaneous image-guided laser photocoagulation for the treatment of spinal osteoid osteoma (OO) in proximity to neural structures. MATERIALS AND METHODS This study was institutional review board-approved with waivers of informed consent. From January 1994 until October 2014, 58 patients with spinal OO (mean age, 25 years; 40 men, 17 women) were treated in one institution by using laser photocoagulation with combined computed tomographic (CT) and fluoroscopic guidance. One patient was excluded because of less than 3 months of follow-up. All patients had typical clinical and imaging findings. Clinical features, radiologic data, and procedure-related data were reviewed, and limitations, complications, and failure rate were evaluated. All data were expressed as means ± standard deviation. P values of less than .05 were indicative of statistical significance. RESULTS OO was in the vertebral body for 18 of 57 patients, the neural arch for 21 of 57 patients, and the articular process for 18 of 57 patients. Mean nidal diameter was 8 mm, and the mean distance from the closest neural structure was 6.6 mm (minimum distance, ≤5 mm in 35 of 57 patients). In 35 of 57 patients, no cortical coverage was present between the nidus and neural structure in danger. Mean total energy delivered was 1271 J (2-watt continuous power mode). Thermal insulation (carbon dioxide and/or hydrodissection), temperature monitoring, and electrostimulation were used in 42, 24, and one patient, respectively. Primary clinical success at 1 month was 98.2%. Total recurrence rate was 5.3%. All recurrences were addressed percutaneously. Secondary success rate was 100%. One-year follow-up is available in 54 of 57 patients. No major complications were noted. CONCLUSION Spinal OO can be safely and effectively treated with percutaneous laser photocoagulation. In cases that are less than 8 mm to 10 mm distance and in the absence of cortical coverage, thermal protection techniques of the neural structures should be used.
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Affiliation(s)
- Georgia Tsoumakidou
- From the Departments of Interventional Radiology (G.T., M.A.T., J.G., X.B., A.G.) and Spine Surgery (J.P.S.), Strasbourg University Hospital, 1 pl. de l'Hôpital, 67091 Strasbourg, France
| | - Marie-Aude Thénint
- From the Departments of Interventional Radiology (G.T., M.A.T., J.G., X.B., A.G.) and Spine Surgery (J.P.S.), Strasbourg University Hospital, 1 pl. de l'Hôpital, 67091 Strasbourg, France
| | - Julien Garnon
- From the Departments of Interventional Radiology (G.T., M.A.T., J.G., X.B., A.G.) and Spine Surgery (J.P.S.), Strasbourg University Hospital, 1 pl. de l'Hôpital, 67091 Strasbourg, France
| | - Xavier Buy
- From the Departments of Interventional Radiology (G.T., M.A.T., J.G., X.B., A.G.) and Spine Surgery (J.P.S.), Strasbourg University Hospital, 1 pl. de l'Hôpital, 67091 Strasbourg, France
| | - Jean-Paul Steib
- From the Departments of Interventional Radiology (G.T., M.A.T., J.G., X.B., A.G.) and Spine Surgery (J.P.S.), Strasbourg University Hospital, 1 pl. de l'Hôpital, 67091 Strasbourg, France
| | - Afshin Gangi
- From the Departments of Interventional Radiology (G.T., M.A.T., J.G., X.B., A.G.) and Spine Surgery (J.P.S.), Strasbourg University Hospital, 1 pl. de l'Hôpital, 67091 Strasbourg, France
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Tsoumakidou G, Too CW, Garnon J, Steib JP, Gangi A. Treatment of a spinal aneurysmal bone cyst using combined image-guided cryoablation and cementoplasty. Skeletal Radiol 2015; 44:285-9. [PMID: 25091121 DOI: 10.1007/s00256-014-1967-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 06/17/2014] [Accepted: 07/22/2014] [Indexed: 02/02/2023]
Abstract
The authors describe the case of a 6.6-cm symptomatic spinal aneurysmal bone cyst (ABC) in a 17-year-old athlete treated percutaneously. Surgical treatment was not considered as the first option owing to its invasiveness and associated morbidity. CT-guided cryoablation of the expansile part of the ABC was performed for tumour shrinkage and nerve decompression. Thermal insulation, temperature monitoring and functional control/electrostimulation of the neural structures at risk were applied. Finally, the bony defect was cemented. No complications occurred during the procedure. Complete resolution of the ABC on imaging and clinical improvement were achieved. Percutaneous cryoablation should be considered as an alternative treatment option, especially when tumour size reduction is desired.
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Affiliation(s)
- Georgia Tsoumakidou
- Non-Vascular IR Department, University Hospital of Strasbourg, Strasbourg, France,
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Garnon J, Schlier A, Buy X, Tsoumakidou G, de Mathelin M, Breton E, Gangi A. Evaluation of percutaneous biopsies of renal masses under MRI-guidance: a retrospective study about 26 cases. Eur Radiol 2014; 25:617-23. [DOI: 10.1007/s00330-014-3449-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/11/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
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Uri IF, Garnon J, Tsoumakidou G, Gangi A. An Ice Block: A Novel Technique of Successful Prevention of Cement Leakage Using an Ice Ball. Cardiovasc Intervent Radiol 2014; 38:470-4. [DOI: 10.1007/s00270-014-0991-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/11/2014] [Indexed: 11/24/2022]
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Tsoumakidou G, Borensztein M, Zini C, Garnon J, Gangi A. Postablation Insufficiency Fracture of the Iliac Crest: Management by Percutaneous Screw Fixation. Cardiovasc Intervent Radiol 2013; 37:1126-8. [DOI: 10.1007/s00270-013-0781-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 10/16/2013] [Indexed: 12/15/2022]
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Tsoumakidou G, Garnon J, Ramamurthy N, Buy X, Gangi A. Interest of electrostimulation of peripheral motor nerves during percutaneous thermal ablation. Cardiovasc Intervent Radiol 2013; 36:1624-1628. [PMID: 23665861 DOI: 10.1007/s00270-013-0641-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 04/08/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE We present our experience of utilizing peripheral nerve electrostimulation as a complementary monitoring technique during percutaneous thermal ablation procedures; and we highlight its utility and feasibility in the prevention of iatrogenic neurologic thermal injury. METHODS Peripheral motor nerve electrostimulation was performed in 12 patients undergoing percutaneous image-guided thermal ablations of spinal/pelvic lesions in close proximity to the spinal cord and nerve roots. Electrostimulation was used in addition to existing insulation (active warming/cooling with hydrodissection, passive insulation with CO2 insufflation) and temperature monitoring (thermocouples) techniques. Impending neurologic deficit was defined as a visual reduction of muscle response or need for a stronger electric current to evoke muscle contraction, compared with baseline. RESULTS Significant reduction of the muscle response to electrostimulation was observed in three patients during the ablation, necessitating temporary interruption, followed by injection of warm/cool saline. This resulted in complete recovery of the muscle response in two cases, while for the third patient the response did not improve and the procedure was terminated. No patient experienced postoperative motor deficit. CONCLUSION Peripheral motor nerve electrostimulation is a simple, easily accessible technique allowing early detection of impending neurologic injury during percutaneous image-guided thermal ablation. It complements existing monitoring techniques and provides a functional assessment along the whole length of the nerve.
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Affiliation(s)
- Georgia Tsoumakidou
- University Hospital of Strasbourg, 1 Pl. de l Hopital, 67000, Strasbourg, France.
| | - Julien Garnon
- University Hospital of Strasbourg, 1 Pl. de l Hopital, 67000, Strasbourg, France
| | - Nitin Ramamurthy
- University Hospital of Strasbourg, 1 Pl. de l Hopital, 67000, Strasbourg, France
| | - Xavier Buy
- University Hospital of Strasbourg, 1 Pl. de l Hopital, 67000, Strasbourg, France
| | - Afshin Gangi
- University Hospital of Strasbourg, 1 Pl. de l Hopital, 67000, Strasbourg, France
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Gangi A, Tsoumakidou G, Abdelli O, Buy X, de Mathelin M, Jacqmin D, Lang H. Percutaneous MR-guided cryoablation of prostate cancer: initial experience. Eur Radiol 2012; 22:1829-35. [PMID: 22752525 DOI: 10.1007/s00330-012-2411-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 12/19/2011] [Accepted: 12/29/2011] [Indexed: 01/12/2023]
Abstract
OBJECTIVE We report our initial experience and the technical feasibility of transperineal prostate cryoablation under MR guidance. METHODS Percutaneous MR-guided cryoablation was performed in 11 patients with prostatic adenocarcinoma contraindicated for surgery (mean age: 72 years, mean Gleason score: 6.45, mean prostate-specific antigen (PSA): 6.21 ng/ml, T1-2c/N0/M0, mean: prostate volume 36.44 ml). Free-hand probe positioning was performed under real-time MR imaging. Four to seven cryoprobes were inserted into the prostate, depending on gland volume. The ice ball was monitored using real-time and high-resolution BLADE multi-planar imaging. Patients were followed at 1, 3, 6, 9 and 12 months after the procedure with serum PSA level and post-ablation MRI. RESULTS Prostate cryoablation was technically feasible in 10/11 patients. The ice ball was clearly and sharply visualised in all cases as a signal-void area. Mean ice-ball volume was 53.3 ml. Mean follow-up was 15 months (range: 1-25). Mean PSA nadir was 0.33 ng/ml (range: 0.02-0.94 ng/ml). Mean hospitalisation was 5 days (range: 3-13). Complications included a urethro-rectal fistula, urinary infection, transient dysuria and scrotal pain. CONCLUSIONS MR-guided prostate cryoablation is feasible and promising, with excellent monitoring of the ice ball. Future perspectives could include the use of MR guidance for focal prostate cancer cryotherapy. KEY POINTS • Magnetic resonance allows precise positioning of cryoprobes with real-time imaging. • High-resolution MRI allows excellent monitoring of the developing ice ball. • Cryoablation of prostate cancer under MR guidance is technically feasible. • Further work will refine the procedure and make it even safer.
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Affiliation(s)
- Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg, France.
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Gangi A, Buy X, Garnon J, Tsoumakidou G, Moser T, Bierry G, Muller A. Traitement de la douleur en oncologie. ACTA ACUST UNITED AC 2011; 92:801-13. [DOI: 10.1016/j.jradio.2011.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 07/21/2011] [Indexed: 10/17/2022]
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Tsoumakidou G, Buy X, Garnon J, Enescu J, Gangi A. Percutaneous Thermal Ablation: How to Protect the Surrounding Organs. Tech Vasc Interv Radiol 2011; 14:170-6. [DOI: 10.1053/j.tvir.2011.02.009] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Gangi A, Tsoumakidou G, Buy X, Cabral J, Garnon J. Percutaneous Techniques for Cervical Pain of Discal Origin. Semin Musculoskelet Radiol 2011; 15:172-80. [DOI: 10.1055/s-0031-1275601] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Affiliation(s)
- A Gangi
- Non-Vascular Interventional Radiology Department, Strasbourg University Hospital, 67091 Strasbourg, Cedex, France.
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Abstract
Today, endovascular aortic aneurysm repair (EVAR) is used as an alternative to open surgery. Although the peri-procedural mortality rate is lower with EVAR, there is a high rate of re-intervention that makes long-term surveillance necessary; therefore, we reviewed the possible complications that can occur after EVAR and focused on the different imaging strategies used for follow-up. So far, multidetector computed tomography angiography (MDCTA) is the most widely accepted surveillance method, but carries the risk of radiation and contrast nephrotoxicity. Radiography, MRA, duplex and contrast-enhanced ultrasonography can also provide high-quality imaging, each with its own advantages and limitations. The ideal follow-up protocol (time intervals and type of imaging modality) needs to be further defined in order to ensure proper endograft function and prevent complications.
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Lagios K, Avgerinos ED, Tsoumakidou G, Perdikides T. Emergency Management of a Fenestration-related Endoleak. J Vasc Interv Radiol 2010; 21:163-5. [DOI: 10.1016/j.jvir.2009.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2009] [Revised: 08/30/2009] [Accepted: 09/29/2009] [Indexed: 10/20/2022] Open
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