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Mutlu IN, Cingoz M, Guzelbey T, Cingoz E, Kilickesmez O. Percutaneous CT-Guided Microwave Ablation for the Treatment of Osteoid Osteomas: A Single Center Experience. Acad Radiol 2024:S1076-6332(24)00095-3. [PMID: 38490842 DOI: 10.1016/j.acra.2024.02.025] [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: 01/20/2024] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 03/17/2024]
Abstract
RATIONALE AND OBJECTIVES The aim of the current study was to evaluate the feasibility and effectiveness of CT-guided microwave ablation (MWA) in the treatment of osteoid osteomas (OO). MATERIALS AND METHODS Data from 59 consecutive patients who underwent percutaneous CT-MWA for OO treatment were examined in the current retrospective study. The period of this study spanned from January 2021 to May 2023 at a single institution. The study involved an evaluation of clinical and radiological characteristics, procedural data, Visual Analog Scale (VAS) pain scores, complication incidences, as well as clinical and technical success rates. Statistical analyses were performed by using the Wilcoxon test with Bonferroni correction, Friedman, Spearman, Mann-Whitney U test. RESULTS 59 patients with an average age of 17.31 ± 8.53 years underwent CT-guided MWA for the treatment of OO. The procedure demonstrated a high success rate, with 96.6% of cases achieving both technical and clinical success. However, recurrence was observed in two patients (3.4%) at the three-month follow-up. These cases were successfully managed with a second MWA procedure. The median VAS pain scores reported by the patients was significantly improved post-procedure: from 8.64 ± 1.14 before treatment to 0.63 ± 0.98 in the first month, 0.41 ± 1.02 in the third month, and 0.15 ± 0.45 in the sixth month. Only one patient (1.7%) experienced a minor complication; no major complications were recorded in this study. CONCLUSION CT-guided percutaneous MWA is a minimally invasive and a highly effective and safe approach for the treatment of OO.
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Affiliation(s)
- Ilhan Nahit Mutlu
- Department of Radiology, Basaksehir Cam And Sakura City Hospital, Basaksehir 34480, Istanbul, Turkey
| | - Mehmet Cingoz
- Department of Radiology, Basaksehir Cam And Sakura City Hospital, Basaksehir 34480, Istanbul, Turkey.
| | - Tevfik Guzelbey
- Department of Radiology, Basaksehir Cam And Sakura City Hospital, Basaksehir 34480, Istanbul, Turkey
| | - Eda Cingoz
- Department of Radiology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Kilickesmez
- Department of Radiology, Basaksehir Cam And Sakura City Hospital, Basaksehir 34480, Istanbul, Turkey
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2
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Bex A, Bex V, Carpentier A, Mathon B. Therapeutic ultrasound: The future of epilepsy surgery? Rev Neurol (Paris) 2022; 178:1055-1065. [PMID: 35853776 DOI: 10.1016/j.neurol.2022.03.015] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 02/08/2023]
Abstract
Epilepsy is one of the leading neurological diseases in both adults and children and in spite of advancement in medical treatment, 20 to 30% of patients remain refractory to current medical treatment. Medically intractable epilepsy has a real impact on a patient's quality of life, neurologic morbidity and even mortality. Actual therapy options are an increase in drug dosage, radiosurgery, resective surgery and non-resective neuromodulatory treatments (deep brain stimulation, vagus nerve stimulation). Resective, thermoablative or neuromodulatory surgery in the treatment of epilepsy are invasive procedures, sometimes requiring long stay-in for the patients, risks of permanent neurological deficit, general anesthesia and other potential surgery-related complications such as a hemorrhage or an infection. Radiosurgical approaches can trigger radiation necrosis, brain oedema and transient worsening of epilepsy. With technology-driven developments and pursuit of minimally invasive neurosurgery, transcranial MR-guided focused ultrasound has become a valuable treatment for neurological diseases. In this critical review, we aim to give the reader a better understanding of current advancement for ultrasound in the treatment of epilepsy. By outlining the current understanding gained from both preclinical and clinical studies, this article explores the different mechanisms and potential applications (thermoablation, blood brain barrier disruption for drug delivery, neuromodulation and cortical stimulation) of high and low intensity ultrasound and compares the various possibilities available to patients with intractable epilepsy. Technical limitations of therapeutic ultrasound for epilepsy surgery are also detailed and discussed.
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Affiliation(s)
- A Bex
- Department of Neurosurgery, CHR Citadelle, Liege, Belgium; Department of Neurosurgery, Sorbonne University, AP-HP, La Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - V Bex
- Department of Neurosurgery, CHR Citadelle, Liege, Belgium
| | - A Carpentier
- Department of Neurosurgery, Sorbonne University, AP-HP, La Pitié-Salpêtrière Hospital, 75013, Paris, France; Sorbonne University, GRC 23, Brain Machine Interface, AP-HP, La Pitié-Salpêtrière Hospital, 75013 Paris, France; Sorbonne University, Advanced Surgical Research Technology Lab, Paris, France
| | - B Mathon
- Department of Neurosurgery, Sorbonne University, AP-HP, La Pitié-Salpêtrière Hospital, 75013, Paris, France; Sorbonne University, GRC 23, Brain Machine Interface, AP-HP, La Pitié-Salpêtrière Hospital, 75013 Paris, France; Sorbonne University, Advanced Surgical Research Technology Lab, Paris, France; Paris Brain Institute, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne University, UMRS, 1127 Paris, France.
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3
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Pereira PL, Vogl TJ, Helmberger T. [International comparison of radiological aspects of the new German S3 guideline on hepatocellular carcinoma and intrahepatic cholangiocarcinoma]. Radiologe 2022; 62:253-262. [PMID: 35181824 DOI: 10.1007/s00117-022-00968-x] [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] [Accepted: 01/12/2022] [Indexed: 12/01/2022]
Abstract
The updated German S3 guideline "Diagnostics and therapy of hepatocellular carcinoma and biliary carcinomas" covers two tumor entities. The original guideline published in 2013 focusing only on the diagnosis and therapy of hepatocellular carcinoma (HCC) has been expanded to include intrahepatic cholangiocarcinoma. These guidelines were developed within the framework of the guideline program on oncology of the Scientific Medical Society e. V. (AWMF), the German Cancer Society (DKG) and German Cancer Aid Society (DKG) under the auspices of the German Society for Digestive and Metabolic Diseases (DGVS). In addition to updated recommendations regarding histopathology, radiological diagnostics and treatments, the main innovations of the revised guidelines on HCC include a complete revision of the section on the systemic therapeutic approach in advanced stages of the disease. This article presents the significance of the current recommendations for diagnostic and interventional radiology in comparison to other national and international guidelines and should serve to improve the quality of patient care through more widespread dissemination.
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Affiliation(s)
- Philippe L Pereira
- Zentrum für Radiologie, Minimal-invasive Therapie und Nuklearmedizin, SLK-Kliniken GmbH, Am Gesundbrunnen 20-26, 74078, Heilbronn, Deutschland.
| | - Thomas J Vogl
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe Universität, Frankfurt am Main, Deutschland
| | - Thomas Helmberger
- Institut für Radiologie, Neuroradiologie und minimal-invasive Therapie, München Klinik Bogenhausen, München, Deutschland
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4
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Zhang M, Rodrigues A, Zhou Q, Li G. Focused ultrasound: growth potential and future directions in neurosurgery. J Neurooncol 2021; 156:23-32. [PMID: 34410576 DOI: 10.1007/s11060-021-03820-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/15/2021] [Accepted: 07/31/2021] [Indexed: 12/18/2022]
Abstract
Over the past two decades, vast improvements in focused ultrasound (FUS) technology have made the therapy an exciting addition to the neurosurgical armamentarium. In this time period, FUS has gained US Food and Drug Administration (FDA) approval for the treatment of two neurological disorders, and ongoing efforts seek to expand the lesion profile that is amenable to ultrasonic intervention. In the following review, we highlight future applications for FUS therapy and compare its potential role against established technologies, including deep brain stimulation and stereotactic radiosurgery. Particular attention is paid to tissue ablation, blood-brain-barrier opening, and gene therapy. We also address technical and infrastructural challenges involved with FUS use and summarize the hurdles that must be overcome before FUS becomes widely accepted in the neurosurgical community.
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Affiliation(s)
- Michael Zhang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA. .,Center for Academic Medicine, Neurosurgery, Stanford University School of Medicine, MC 5327, 453 Quarry Road, Palo Alto, CA, 94304, USA.
| | - Adrian Rodrigues
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Quan Zhou
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.,Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Gordon Li
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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Meng Y, Jones RM, Davidson B, Huang Y, Pople CB, Surendrakumar S, Hamani C, Hynynen K, Lipsman N. Technical Principles and Clinical Workflow of Transcranial MR-Guided Focused Ultrasound. Stereotact Funct Neurosurg 2020; 99:329-342. [PMID: 33302282 DOI: 10.1159/000512111] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 07/21/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022]
Abstract
Transcranial MR-guided focused ultrasound (MRgFUS) is a rapidly developing technology in neuroscience for manipulating brain structure and function without open surgery. The effectiveness of transcranial MRgFUS for thermoablation is well established, and the technique is actively employed worldwide for movement disorders including essential tremor. A growing number of centers are also investigating the potential of microbubble-mediated focused ultrasound-induced opening of the blood-brain barrier (BBB) for targeted drug delivery to the brain. Here, we provide a technical overview of the principles, clinical workflow, and operator considerations of transcranial MRgFUS procedures for both thermoablation and BBB opening.
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Affiliation(s)
- Ying Meng
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ryan M Jones
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Davidson
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Yuexi Huang
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Christopher B Pople
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | | | - Clement Hamani
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kullervo Hynynen
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Nir Lipsman
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada, .,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada,
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6
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Radosa CG, Hoffmann RT. [ Thermoablation : Friend and foe of immunotherapy]. Radiologe 2020; 60:704-710. [PMID: 32661583 DOI: 10.1007/s00117-020-00719-w] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evidence from multiple studies have shown the potential of thermal ablative therapies to induce regression of metastases and tumors which are distant from the treated metastases-within the same organ or even in other organs-the so-called abscopal effect. Unfortunately, this effect is most often weak and not always reproducible. Recent developments in systemic therapies showed that immunomodulating drugs are of major interest in patient-tailored tumor therapy due to the fact that they are able to enhance the treatment effect of conventional chemotherapy. Furthermore, several studies and reports showed that these immunomodulating therapies are also able to enhance the response of the immune system to the tumor-if combined with local ablative therapies-and trigger a systemic antitumor response. Unfortunately, there is also evidence that effects caused by thermal ablation can hamper the immune system and, therefore, increase tumor growth and tumor spread. OBJECTIVES In this article, the effects of thermal ablation in general are described, different (thermo-)ablative techniques are presented and a perspective of combination therapies is given.
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Affiliation(s)
- Christoph G Radosa
- Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl-Gustav-Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Ralf-Thorsten Hoffmann
- Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl-Gustav-Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
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7
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Papini E, Monpeyssen H, Frasoldati A, Hegedüs L. 2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules. Eur Thyroid J 2020; 9:172-185. [PMID: 32903999 PMCID: PMC7445670 DOI: 10.1159/000508484] [Citation(s) in RCA: 194] [Impact Index Per Article: 48.5] [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: 04/24/2020] [Accepted: 05/07/2020] [Indexed: 12/17/2022] Open
Abstract
Standard therapeutic approaches for benign thyroid lesions that warrant intervention are surgery for cold and either surgery or radioiodine for autonomously functioning thyroid nodules (AFTN). Image-guided thermal ablation (TA) procedures are increasingly proposed as therapy options for selected clinical conditions. Due to mounting scientific evidence and widening availability, ETA considered it appropriate to develop guidelines for the use of TA in adult patients. TA procedures are well tolerated, but a dedicated training of the operators is required and information on possible complications needs to be shared with the patients. The following factors should be considered when weighing between observation, surgery, and TA for benign thyroid nodules. In solid non-hyperfunctioning nodules, TA induces a decrease in thyroid nodule volume, paralleled by improvement in symptoms. Nodule re-growth is possible over time and may necessitate repeat treatment, or surgery, in a dialogue with the patient. In AFTN, radioactive iodine is the first-line treatment, but TA may be considered in young patients with small AFTN due to higher probability of restoring normal thyroid function and avoidance of irradiation. In cystic nodules, ethanol ablation (EA) is the most effective and least expensive treatment. TA may be considered for cystic lesions that relapse after EA or have a significant residual solid component following drainage and EA. TA should be restricted to benign lesions that cause symptoms or cosmetic concern. Presently, laser and radiofrequency ablation are the most thoroughly assessed techniques, with similar satisfactory clinical results. Microwaves and high-intensity focused ultrasound therapy options remain to be fully evaluated.
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Affiliation(s)
- Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | | | - Andrea Frasoldati
- Department of Endocrinology and Metabolism, Arcispedale Santa Maria Nuova IRCCS-ASL, Reggio Emilia, Italy
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
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8
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Kamath AA, Friedman DD, Akbari SHA, Kim AH, Tao Y, Luo J, Leuthardt EC. Glioblastoma Treated With Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy: Safety, Efficacy, and Outcomes. Neurosurgery 2020; 84:836-843. [PMID: 30137606 PMCID: PMC6425465 DOI: 10.1093/neuros/nyy375] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 07/19/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the multitude of available treatments, glioblastoma (GBM) remains an aggressive and uniformly fatal tumor. Laser interstitial thermal therapy (LITT) is a novel, minimally invasive treatment that holds promise for treating patients with GBM who are not candidates for traditional open craniotomy. However, due to the recent introduction of LITT into clinical practice, large series that evaluate safety and long-term outcomes after LITT are lacking. OBJECTIVE To present our institution's series of over 50 GBM patients treated with LITT, with regard to safety, efficacy, and outcomes. METHODS We performed a retrospective descriptive study of patients with histologically proven GBM who underwent LITT. Data collected included demographics, tumor location and volume, tumor genetic markers, treatment volume, perioperative complications, and long-term follow-up data. RESULTS We performed 58 LITT treatments for GBM in 54 patients over 5.5 yr. Forty-one were recurrent tumors while 17 were frontline treatments. Forty GBMs were lobar in location, while 18 were in deep structures (thalamus, insula, corpus callosum). Average tumor volume was 12.5 ± 13.4 cm3. Average percentage of tumor treated with the yellow thermal damage threshold (TDT) line (dose equivalent of 43°C for 2 min) was 93.3% ± 10.6%, and with the blue TDT line (dose equivalent of 43°C for 10 min) was 88.0% ± 14.2%. There were 7 perioperative complications (12%) and 2 mortalities (3.4%). Median overall survival after LITT for the total cohort was 11.5 mo, and median progression-free survival 6.6 mo. CONCLUSION LITT appears to be a safe and effective treatment for GBM in properly selected patients.
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Affiliation(s)
- Ashwin A Kamath
- Departments of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Daniel D Friedman
- Departments of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - S Hassan A Akbari
- Departments of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Albert H Kim
- Departments of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri.,Department of Neurology, Washington University School of Medicine, St. Louis, Missouri.,Department of Developmental Biology, Washington University School of Medicine, St. Louis, Missouri.,Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Yu Tao
- Department of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Jinqin Luo
- Department of Biostatistics, Washington University School of Medicine, St. Louis, Missouri.,Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Eric C Leuthardt
- Departments of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri.,Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.,Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, Missouri.,Department of Mechanical Engineering and Materials Science, Washington University School of Medicine, St. Louis, Missouri.,Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri.,Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, Missouri.,Brain Laser Center, Washington University School of Medicine, St. Louis, Missouri
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9
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Jermakowicz WJ, Mahavadi AK, Cajigas I, Dan L, Guerra S, Farooq G, Shah AH, D'Haese PF, Ivan ME, Jagid JR, Komotar RJ. Predictive modeling of brain tumor laser ablation dynamics. J Neurooncol 2019; 144:193-203. [PMID: 31240526 DOI: 10.1007/s11060-019-03220-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/16/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Laser interstitial thermal therapy (LITT) is a novel MR thermometry-guided thermoablative tool revolutionizing the clinical management of brain tumors. A limitation of LITT is our inability to estimate a priori how tissues will respond to thermal energy, which hinders treatment planning and delivery. The aim of this study was to determine whether brain tumor LITT ablation dynamics may be predicted by features of the preoperative MRI and the relevance of these data, if any, to the recurrence of metastases after LITT. METHODS Intraoperative thermal damage estimate (TDE) map pixels representative of irreversible damage were retrospectively quantified relative to ablation onset for 101 LITT procedures. Raw TDE pixel counts and TDE pixel counts modelled with first order dynamics were related to eleven independent variables derived from the preoperative MRI, demographics, laser settings, and tumor pathology. Stepwise regression analysis generated predictive models of LITT dynamics, and leave-one-out cross validation evaluated the accuracy of these models at predicting TDE pixel counts solely from the independent variables. Using a deformable atlas, TDE maps were co-registered to the immediate post-ablation MRI, allowing comparison of predicted and actual ablation sizes. RESULTS Brain tumor TDE pixel counts modelled with first order dynamics, but not raw pixel counts, are correlated with the independent variables. Independent variables showing strong relations to the TDE pixel measures include T1 gadolinium and T2 signal, perfusion, and laser power. Associations with tissue histopathology are minimal. Leave-one-out analysis demonstrates that predictive models using these independent variables account for 77% of the variance observed in TDE pixel counts. Analysis of metastases treated revealed a trend towards the over-estimation of LITT effects by TDE maps during rapid ablations, which was associated with tumor recurrence. CONCLUSIONS Features of the preoperative MRI are predictive of LITT ablation dynamics and could eventually be used to improve the clinical efficacy with which LITT is delivered to brain tumors.
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Prud'homme C, Nueffer JP, Runge M, Dubut J, Kastler B, Aubry S. Prospective pilot study of CT-guided microwave ablation in the treatment of osteoid osteomas. Skeletal Radiol 2017; 46:315-323. [PMID: 28028574 DOI: 10.1007/s00256-016-2558-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 04/15/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The aims of this work were to assess the feasibility and efficacy of CT-guided microwave ablation (MWA) in the treatment of osteoid osteomas (OOs). MATERIALS AND METHODS Thirteen consecutive patients (range 11-31 years old) presenting with OO were prospectively included and treated by CT-guided MWA. Power and duration of MWA were both recorded. The patient's pain was assessed using a numeric pain rating scale (NRS), and side effects were recorded during procedures, after 1 day, 7 days and 1 month. The nidus vascularization and the volume of necrosis induced by MWA were assessed using contrast-enhanced MRI. Success was defined as the complete relief of the patient's pain 1 month after the first procedure, associated with necrosis of the nidus on follow-up MRI. RESULTS The success rate was up to 92.3% (12/13). At 1 day, 7 days and 1 month, the median NRSs were respectively 5 [interquartile range (IQR) 2-5], 0 (IQR 0-1) and 0 (IQR 0-0). Side effects observed were one partial and self-resolving lesion of a sensory branch of the radial nerve and two skin burns. The median power of the MWA used was 60 W (IQR 50-60) with a 1.5-min duration (IQR 1-2), leading to MWA-induced necrosis measuring on average 23 × 15 × 16 mm. CONCLUSION CT-guided MWA of OO has a success rate that appears to be almost similar to that of laser or radiofrequency ablation, but care must be taken to prevent nerve or skin lesions.
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Affiliation(s)
- Clara Prud'homme
- Department of Musculoskeletal Imaging, University Hospital of Besancon, 25000, Besancon, France
| | - Jean-Philippe Nueffer
- Department of Musculoskeletal Imaging, University Hospital of Besancon, 25000, Besancon, France
| | - Michel Runge
- Department of Musculoskeletal Imaging, University Hospital of Besancon, 25000, Besancon, France
| | - Jonathan Dubut
- Department of Musculoskeletal Imaging, University Hospital of Besancon, 25000, Besancon, France
| | - Bruno Kastler
- Department of Musculoskeletal Imaging, University Hospital of Besancon, 25000, Besancon, France.,I4S Laboratory, INSERM EA4268, University of Franche-Comte, 25000, Besancon, France
| | - Sébastien Aubry
- Department of Musculoskeletal Imaging, University Hospital of Besancon, 25000, Besancon, France. .,Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, 25000, Besancon, France.
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11
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Arrigoni F, Barile A, Zugaro L, Splendiani A, Di Cesare E, Caranci F, Ierardi AM, Floridi C, Angileri AS, Reginelli A, Brunese L, Masciocchi C. Intra-articular benign bone lesions treated with Magnetic Resonance-guided Focused Ultrasound (MRgFUS): imaging follow-up and clinical results. Med Oncol 2017; 34:55. [PMID: 28244018 DOI: 10.1007/s12032-017-0904-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 01/23/2017] [Accepted: 02/12/2017] [Indexed: 12/23/2022]
Abstract
Purpose of this study was to evaluate the employment of MRI-guided Focused Ultrasound (MRgFUS) for treatment of intra-articular benign bone lesions as alternative to surgery, and to monitor the success of the treatment on CT and MRI images. From March 2011 to August 2013, 14 intra-articular benign bone lesions were treated with MRgFUS. All patients were studied by CT and MR imaging. Pain was measured using the visual analogue scale (VAS) before and after treatment (6 and 12 months). All patients in our series demonstrated regression in painful symptomatology during screening. A significant drop in the mean VAS pain score (from 7.8 to 0.6) was observed at 12-month follow-up, and pain medication was no longer needed after treatment. No complications were observed. Three diagnostic imaging signs were found suggesting absence of biological activity and confirming the clinical findings: calcification of the treated lesion, lack of contrast enhancement and disappearance of bone oedema around the lesions. CONCLUSION the employment of MRgFUS is safe and effective in the treatment of intra-articular benign bone lesions. The clinical outcome is satisfactory, and the success of the treatment is confirmed by diagnostic imaging.
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Affiliation(s)
- Francesco Arrigoni
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy.
| | - Antonio Barile
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Luigi Zugaro
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Alessandra Splendiani
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Ernesto Di Cesare
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Ferdinando Caranci
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | | | - Chiara Floridi
- Department of Radiology, Insubria University, Varese, Italy
| | | | - Alfonso Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy
| | - Luca Brunese
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Carlo Masciocchi
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
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12
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Silverman ER, Lai YH, Osborn IP, Yudkowitz FS. Percutaneous radiofrequency ablation of hepatocellular lesions in segment II of the liver: a risk factor for cardiac tamponade. J Clin Anesth 2013; 25:587-90. [PMID: 23988803 DOI: 10.1016/j.jclinane.2013.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 07/28/2012] [Revised: 03/20/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
Abstract
Percutaneous radiofrequency ablation (PRFA) is a minimally invasive procedure used for the treatment of small hepatocellular carcinomas. PRFA is regarded as a much safer alternative to surgical resection or orthotopic liver transplantation. However, serious complications, including cardiac tamponade, have been reported. Two cases of severe cardiac tamponade during PRFA were successfully treated.
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Affiliation(s)
- Eric R Silverman
- Department of Anesthesiology, Montefiore Medical Center, Bronx, NY 10467, USA.
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Künzli BM, Abitabile P, Maurer CA. Radiofrequency ablation of liver tumors: Actual limitations and potential solutions in the future. World J Hepatol 2011; 3:8-14. [PMID: 21307982 PMCID: PMC3035700 DOI: 10.4254/wjh.v3.i1.8] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 12/07/2010] [Accepted: 12/14/2010] [Indexed: 02/06/2023] Open
Abstract
Over the past decade, radiofrequency ablation (RFA) has evolved into an important therapeutical tool for the treatment of non resectable primary and secondary liver tumors. The clinical benefit of RFA is represented in several clinical studies. They underline the safety and feasibility of this new and modern concept in treating liver tumors. RFA has proven its clinical impact not only in hepatocellular carcinoma (HCC) but also in metastatic disease such as colorectal cancer (CRC). Due to the increasing number of HCC and CRC, RFA might play an even more important role in the future. Therefore, the refinement of RFA technology is as important as the evaluation of data of prospective randomized trials that will help define guidelines for good clinical practice in RFA application in the future. The combination of hepatic resection and RFA extends the feasibility of open surgical procedures in patients with extensive tumors. Adverse effects of RFA such as biliary tract damage, liver failure and local recurrence remain an important task today but overall the long term results of RFA application in treating liver tumors are promising. Incomplete ablation of liver tumors due to insufficient technology of ablation needles, tissue cooling by the neighbouring blood vessels, large tumor masses and ablation of tumors in close vicinity to heat sensitive organs remain difficult tasks for RFA. Future solutions to overcome these limitations of RFA will include refinement of ultrasonographic guidance (accuracy of probe placement), improvements in needle technology (e.g. needles preventing charring) and intraductal cooling techniques.
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Affiliation(s)
- Beat M Künzli
- Beat M Künzli, Paolo Abitabile, Christoph A Maurer, Department of Surgery, Kantonsspital Liestal, Liestal, CH-4416, Switzerland
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