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Abstract No. 305: Percutaneous vertebroplasty performed by the unilateral transpedicular method
JVIR 䡲 Poster Sessions
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benefits. Percutaneous renal cryoablation has encouraging early results as a minimally invasive, nephron sparing technique for select patients with early stage renal cell carcinoma (RCC). The objective of this study is to report the impact of CT/ US fusion imaging and EM tracking in percutaneous cryoablation of RCC. Materials and Methods: With IRB approval, we performed a retrospective review of our percutaneous renal cryoablations, comparing non-fusion guided ablations from June 2009 to December 2009, with fusion guided ablations from January 2010 to July 2010. The fusion software (GE Medical) combined real-time ultrasound images (GE Logiq E9) with the localizing prone CT exams. Diagnostic biopsy was attempted for each lesion followed immediately by a standard 10 min double freeze/thaw cryoablation protocol. Data was collected on positive biopsy rates, pre- and post-procedural creatinine levels, probe positioning, radiation exposure, and procedure time. Results: 36 consecutive renal cryoablation patients, including 24 non-fusion and 12 fusion, were studied in a retrospective fashion. The biopsy rates for RCC were 7/11 (63.6%) in the fusion arm, and 14/24 (58.3%) in the non-fusion arm. The radiation exposure (Dose Linear Product) was 2961.8 mGy-cm in the fusion arm, and 2707.4 mGy-cm in the non-fusion arm (p⫽0.59). An average of 2.54 probe positions were made in the fusion arm, and 2.75 needle positions in the non-fusion arm (p⫽0.71). The procedure time for the fusion arm averaged 1 hour and 33 minutes, and 1 hour 13 minutes in the non-fusion arm. Conclusion: In this series, there was no significant difference in outcomes with the use of advanced guidance and probe tracking, though a trend toward higher positive biopsy rates and fewer probe placements exists. These data may reflect the learning curve associated with the use of the guidance system and further analysis and correlation with oncologic outcomes will be necessary.
Abstract No. 304 Percutaneous cryoablation of renal masses: The impact of patient selection H. Yarmohammadi1, G. Vricella2, J. Haaga1, D.A. Nakamoto1, B.L. Adler2, E.E. Cherullo2, L.E. Ponsky2; 1Radiology, University Hospitals Case Medical Center, Cleveland, OH; 2Urology, University Hospitals Case Medical Center, Cleveland, OH
See also Abstract No. 386
Musculoskeletal Interventions Abstract No. 305 Percutaneous vertebroplasty performed by the unilateral transpedicular method L. Chen, R. Ni; Interventioanal Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China Purpose: To evaluate the feasibility of using the modified unilateral transpedicular approach on percutaneous vertebroplasty (PVP) and compare the radiographic and clinical outcomes of a unipediculate approach with those of standard bipediculate vertebroplasty. Materials and Methods: Retrospective review of PVP yielded 41 vertebrae in 32 patients that were treated with a standard bipediculate approach and 98 vertebrae in 65 patients that were treated with a modified unipediculate approach. The puncture angle and the distance frome the skin entry site to the spinous process were recorded in two groups. Anteroposterior radiographs obtained after the procedure were viewed to calculate the percentage of cement opacification in both vertebral halves, and mean values were compared between uni- and bipediculate approaches by using a two-tailed Student t test. The score of visual analogue scale point (VAS) (10-point scale) before PVP and one month after PVP was recorded and compared in the two groups by using the repeated ANOVA test. Results: With the unipediculate approach, the accuracy of puncture to the median vertebral body was achieved in 92(93.9%) of 98 injections. Mean distance frome the skin entry site to the spinous process was 3.9 ⫾ 0.5cm and 4.6 ⫾ 0.8cm for the bipediculate and unipediculate approaches, respectively (p⬍0.05). Mean puncture angle was 19 ⫾ 2.3° and 31 ⫾ 4.5° for the bipediculate and unipediculate approaches, respectively (p⬍0.05). Mean opacification of vertebral body halves was 82.3% ⫾ 16.1 and 75.7% ⫾ 12.1% for the bipediculate and unipediculate approaches, respectively (p⬎0.05). Among patients with one month follow-up data, the unipedicular and bipedicular approaches achieved adequate pain relief with mean decreases in pain severity of 5.8 ⫾ 1.3 and 5.6 ⫾ 1.5, respectively. No significant difference in the treatment effect between the two groups was observed. Conclusion: Completion rate of PVP by the modified unilateral transpedicular approach is high. Use of a unipediculate approach
Poster Sessions
Purpose: The aim of this study was to assess the patient and treatment parameters that are predictive of treatment failure or post-procedure complications. Materials and Methods: Fifty-two consecutive patients with 54 renal tumors that underwent cryoablation were analyzed in this retrospective study. Parameters that were collected were: Demographic characteristics (age, gender, and body mass index), serum creatinine, size of the mass, lesion laterality, age-adjusted Charlson comorbidity index (AA-CCI), American Society of Anesthesia (ASA) class, number of probes used and total freezing time. Procedure was performed under general anesthesia and using CT guidance. Every lesion received at least 2 and up to 4 freeze-thaw cycles with margin of ice of 1 cm. Follow up was performed at 23-hours, 2 weeks and 3, 6, and 12 months after obtaining a contrast-enhanced CT or MRI. Results: Mean age was 69 y/o (range 47– 86) with a mean tumor size of 2.5 cm (range 0.6 – 6.2). A mean of three probes (range 1–5) were used for each cryoablation. Mean total freezing time was 23.3 minutes (range of 13– 40). Average freeze cycle was 2.5
(2– 4). Complication rate was 12% (6 patients) and were retroperitoneal bleeds requiring transfusion (3/52), hematocrit drop (1/52), renal abscess (1/52), and readmission for pulmonary emboli (1/ 52). Patients with an AA-CCI score greater than or equal to 5.0 had a significantly higher rate of complications and treatment failure (p ⬍ 0.005). Overall survival rate for 21 month follow-up was 98.1%. Two patients demonstrated treatment failure. Conclusion: Age-adjusted Charlson comorbidity index score and number of cryoprobes used were the variables that predicted value for outcomes in terms of complication rates.
Poster Sessions 䡲 JVIR
S128
in percutaneous vertebroplasty allows filling of both vertebral halves from a single puncture site with no statistically significant difference in clinical outcome from that of bipediculate vertebroplasty.
Abstract No. 306 Efficacy of percutaneous interspinous spacer in the treatment of neurogenic intermittent claudication due to lumbar spinal stenosis S. Marcia1, G. Anselmetti2, E. Piras1, A. Sanna1, C. Boi1, S. Marini1, M. Marras1, G. Mallarini1; 1Radiology, University of Cagliari, Cagliari, Italy; 2Radiology, IRCC, Candiolo(TO), Italy Purpose: Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal: LSS degenerative type usually affects people aged over 50 years and causes several symptoms, in particular neurogenic intermittent claudication (NIC). The aim of this study is to provide the efficacy of a totally percutaneous interspinous spacer. Materials and Methods: Sixty-three patients (27Male, 36Female) with NIC due to LSS were selected for implantation of percutaneous interspinous spacer. Diagnosis was confirmed by conventional X-Ray, CT and MRI. Each procedure was performed using the Aperius PercLID system (Kyphon Medtronic). All devices were implanted under fluoroscopic guidance and with local anesthesia. Clinical evaluation, assessment of pain by mean of a 11-points visual analogue scale (VAS, 0 –10) and of function by means of the Oswestry disability scale (ODI 0 –50) was performed at baseline and at one month after the procedure. CTms checks has been performed before and after the procedure and at one month. We also evaluated the areas of the foramens and of the spinal canal before and after the implantation. Results: A total of 69 intervertebral spaces were treated in the 69 patients enrolled in the study. Baseline pain was 8.1 ⫾ 2.0, baseline ODI was 23.3 ⫾ 10.0. At one month, pain was 4.4 ⫾ 2.0, while ODI was 11.7 ⫾ 8.5 (p⬍0.01). We reported an increase of 14.8% e 15.3% in the areas of the foramens (Av. Area Dx before: 0.97, after: 1.11mm3, Av. Area Sn before: 0.95, after: 1.09mm3) and an increase of 15.3% in spinal canal dimension (Av. Axial area before: 1.85, after: 2.14mm3). No intraprocedural side effects, one dislocation was reported after three days. Conclusion: Implant of percutaneous interspinous spacer is an effective and safe procedure in reducing neurogenic intermittent claudication in patients with lumbar spinal stenosis.
Non-vascular Interventions Poster Sessions
Abstract No. 307 Factors affecting the success of deep pelvic abscess drainage T. Ciftci1, O. Ergun1, U. Arslan2, D. Akinci1, O. Akhan1; 1 Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey; 2Department of Biostatistics, Hacettepe University, School of Medicine, Ankara, Turkey
Purpose: To evaluate the effects of factors on deep pelvic abscess drainage results retrospectively. Materials and Methods: Between 2002–2009 total 185 pelvic abscesses were treated in 163 patients under ultrasonograpy (US) and fluoroscopy (n⫽140) or computed tomography (CT, n⫽45) guidance via transabdominal, transvaginal, transrectal and transgluteal access routes. The effects of factors related with abscess (etiology, quantity, size, intrasturucture, microbiological content, presence of fistula), patient (age, sex, immune status, presence of malignancy, primary disease, being under antibiotic treatment before the procedure) and procedure (guidance method, access route, size of catheter) on clinical success, complications and catheter duration were statistically analyzed. Mann Whitney U and one way ANOVA tests were used as quantitative tests to compare two and three groups respectively whereas Fisher’s Exact and Likelihood Ratio Chi-square tests were used as qualitative tests to compare two and more than two groups respectively. Results: Technical and clinical success rates were 100% and 93.9% respectively. Fistulization was observed in 14 abscesses. Procedure related mortality or major complications were not observed. Minor complications such as catheter removal or break were determined in 7% of the patients. 10 patients (6.1%) were considered as clinical failure (recurrence n⫽7, mortality related sepsis n⫽2, necessity for surgery n⫽1). According to results fistulization extends catheter duration (P⬍0.05) and also decreases the clinical success rate (P⬍0.05). Presence of underlying disease affecting immunological condition of patient and presence of fungus infection in cavity extends catheter duration (P⬍0.05) without effecting clinical success (P⬎0.05). Transgluteal access route increases the rate of minor complications compared with other routes (P⬍0.05). Conclusion: The only factor affecting the clinical success rate in pelvic abscess treatment is the presence of fistula. Immune status of the patient and presence of fungal infection in the cavity extend the treatment period but they don’t affect clinical success.
Educational Exhibit
Abstract No. 308
Management of malignant distal biliary obstruction in cirrhotic liver: Transcystic duct approach S.E. Hegab; Radiodiagnosis and Intervention Radiology, Alexandria University, Alexandria, Egypt Learning Objectives: Distal extrahepatic biliary obstruction can be managed percutaneously when endoscopic therapy fails. However, transhepatic drainage may itself be unsuccessful especially in cirrhotic liver with non-dilated biliary radicals. In such patients, a transcholecystic approach was used to achieve biliary drainage with subsequent use of percutaneous cholecystostomy tract for biliary stent placement through transcystic approach. The purpose of this study was to evaluate the technical success of percutaneous transcholecystic placement of metallic stent for the treatment of malignant obstruction of the distal common bile duct in cirrhotic liver with non-dilated intrahepatic ducts. Background: This study included four patients with inoperable malignant obstructive lesion at the distal end of the common bile duct, three patients with pancreatic tumour and one patient with infiltrating duodenal carcinoma. In all patients, biliary drainage via transhepatic peripheral duct access or endoscopic retrograde biliary drainage was technically difficult. US guided percutaneous cholecystostomy was performed using 8F single step pig tail
S127
benefits. Percutaneous renal cryoablation has encouraging early results as a minimally invasive, nephron sparing technique for select patients with early stage renal cell carcinoma (RCC). The objective of this study is to report the impact of CT/ US fusion imaging and EM tracking in percutaneous cryoablation of RCC. Materials and Methods: With IRB approval, we performed a retrospective review of our percutaneous renal cryoablations, comparing non-fusion guided ablations from June 2009 to December 2009, with fusion guided ablations from January 2010 to July 2010. The fusion software (GE Medical) combined real-time ultrasound images (GE Logiq E9) with the localizing prone CT exams. Diagnostic biopsy was attempted for each lesion followed immediately by a standard 10 min double freeze/thaw cryoablation protocol. Data was collected on positive biopsy rates, pre- and post-procedural creatinine levels, probe positioning, radiation exposure, and procedure time. Results: 36 consecutive renal cryoablation patients, including 24 non-fusion and 12 fusion, were studied in a retrospective fashion. The biopsy rates for RCC were 7/11 (63.6%) in the fusion arm, and 14/24 (58.3%) in the non-fusion arm. The radiation exposure (Dose Linear Product) was 2961.8 mGy-cm in the fusion arm, and 2707.4 mGy-cm in the non-fusion arm (p⫽0.59). An average of 2.54 probe positions were made in the fusion arm, and 2.75 needle positions in the non-fusion arm (p⫽0.71). The procedure time for the fusion arm averaged 1 hour and 33 minutes, and 1 hour 13 minutes in the non-fusion arm. Conclusion: In this series, there was no significant difference in outcomes with the use of advanced guidance and probe tracking, though a trend toward higher positive biopsy rates and fewer probe placements exists. These data may reflect the learning curve associated with the use of the guidance system and further analysis and correlation with oncologic outcomes will be necessary.
Abstract No. 304 Percutaneous cryoablation of renal masses: The impact of patient selection H. Yarmohammadi1, G. Vricella2, J. Haaga1, D.A. Nakamoto1, B.L. Adler2, E.E. Cherullo2, L.E. Ponsky2; 1Radiology, University Hospitals Case Medical Center, Cleveland, OH; 2Urology, University Hospitals Case Medical Center, Cleveland, OH
See also Abstract No. 386
Musculoskeletal Interventions Abstract No. 305 Percutaneous vertebroplasty performed by the unilateral transpedicular method L. Chen, R. Ni; Interventioanal Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China Purpose: To evaluate the feasibility of using the modified unilateral transpedicular approach on percutaneous vertebroplasty (PVP) and compare the radiographic and clinical outcomes of a unipediculate approach with those of standard bipediculate vertebroplasty. Materials and Methods: Retrospective review of PVP yielded 41 vertebrae in 32 patients that were treated with a standard bipediculate approach and 98 vertebrae in 65 patients that were treated with a modified unipediculate approach. The puncture angle and the distance frome the skin entry site to the spinous process were recorded in two groups. Anteroposterior radiographs obtained after the procedure were viewed to calculate the percentage of cement opacification in both vertebral halves, and mean values were compared between uni- and bipediculate approaches by using a two-tailed Student t test. The score of visual analogue scale point (VAS) (10-point scale) before PVP and one month after PVP was recorded and compared in the two groups by using the repeated ANOVA test. Results: With the unipediculate approach, the accuracy of puncture to the median vertebral body was achieved in 92(93.9%) of 98 injections. Mean distance frome the skin entry site to the spinous process was 3.9 ⫾ 0.5cm and 4.6 ⫾ 0.8cm for the bipediculate and unipediculate approaches, respectively (p⬍0.05). Mean puncture angle was 19 ⫾ 2.3° and 31 ⫾ 4.5° for the bipediculate and unipediculate approaches, respectively (p⬍0.05). Mean opacification of vertebral body halves was 82.3% ⫾ 16.1 and 75.7% ⫾ 12.1% for the bipediculate and unipediculate approaches, respectively (p⬎0.05). Among patients with one month follow-up data, the unipedicular and bipedicular approaches achieved adequate pain relief with mean decreases in pain severity of 5.8 ⫾ 1.3 and 5.6 ⫾ 1.5, respectively. No significant difference in the treatment effect between the two groups was observed. Conclusion: Completion rate of PVP by the modified unilateral transpedicular approach is high. Use of a unipediculate approach
Poster Sessions
Purpose: The aim of this study was to assess the patient and treatment parameters that are predictive of treatment failure or post-procedure complications. Materials and Methods: Fifty-two consecutive patients with 54 renal tumors that underwent cryoablation were analyzed in this retrospective study. Parameters that were collected were: Demographic characteristics (age, gender, and body mass index), serum creatinine, size of the mass, lesion laterality, age-adjusted Charlson comorbidity index (AA-CCI), American Society of Anesthesia (ASA) class, number of probes used and total freezing time. Procedure was performed under general anesthesia and using CT guidance. Every lesion received at least 2 and up to 4 freeze-thaw cycles with margin of ice of 1 cm. Follow up was performed at 23-hours, 2 weeks and 3, 6, and 12 months after obtaining a contrast-enhanced CT or MRI. Results: Mean age was 69 y/o (range 47– 86) with a mean tumor size of 2.5 cm (range 0.6 – 6.2). A mean of three probes (range 1–5) were used for each cryoablation. Mean total freezing time was 23.3 minutes (range of 13– 40). Average freeze cycle was 2.5
(2– 4). Complication rate was 12% (6 patients) and were retroperitoneal bleeds requiring transfusion (3/52), hematocrit drop (1/52), renal abscess (1/52), and readmission for pulmonary emboli (1/ 52). Patients with an AA-CCI score greater than or equal to 5.0 had a significantly higher rate of complications and treatment failure (p ⬍ 0.005). Overall survival rate for 21 month follow-up was 98.1%. Two patients demonstrated treatment failure. Conclusion: Age-adjusted Charlson comorbidity index score and number of cryoprobes used were the variables that predicted value for outcomes in terms of complication rates.
Poster Sessions 䡲 JVIR
S128
in percutaneous vertebroplasty allows filling of both vertebral halves from a single puncture site with no statistically significant difference in clinical outcome from that of bipediculate vertebroplasty.
Abstract No. 306 Efficacy of percutaneous interspinous spacer in the treatment of neurogenic intermittent claudication due to lumbar spinal stenosis S. Marcia1, G. Anselmetti2, E. Piras1, A. Sanna1, C. Boi1, S. Marini1, M. Marras1, G. Mallarini1; 1Radiology, University of Cagliari, Cagliari, Italy; 2Radiology, IRCC, Candiolo(TO), Italy Purpose: Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal: LSS degenerative type usually affects people aged over 50 years and causes several symptoms, in particular neurogenic intermittent claudication (NIC). The aim of this study is to provide the efficacy of a totally percutaneous interspinous spacer. Materials and Methods: Sixty-three patients (27Male, 36Female) with NIC due to LSS were selected for implantation of percutaneous interspinous spacer. Diagnosis was confirmed by conventional X-Ray, CT and MRI. Each procedure was performed using the Aperius PercLID system (Kyphon Medtronic). All devices were implanted under fluoroscopic guidance and with local anesthesia. Clinical evaluation, assessment of pain by mean of a 11-points visual analogue scale (VAS, 0 –10) and of function by means of the Oswestry disability scale (ODI 0 –50) was performed at baseline and at one month after the procedure. CTms checks has been performed before and after the procedure and at one month. We also evaluated the areas of the foramens and of the spinal canal before and after the implantation. Results: A total of 69 intervertebral spaces were treated in the 69 patients enrolled in the study. Baseline pain was 8.1 ⫾ 2.0, baseline ODI was 23.3 ⫾ 10.0. At one month, pain was 4.4 ⫾ 2.0, while ODI was 11.7 ⫾ 8.5 (p⬍0.01). We reported an increase of 14.8% e 15.3% in the areas of the foramens (Av. Area Dx before: 0.97, after: 1.11mm3, Av. Area Sn before: 0.95, after: 1.09mm3) and an increase of 15.3% in spinal canal dimension (Av. Axial area before: 1.85, after: 2.14mm3). No intraprocedural side effects, one dislocation was reported after three days. Conclusion: Implant of percutaneous interspinous spacer is an effective and safe procedure in reducing neurogenic intermittent claudication in patients with lumbar spinal stenosis.
Non-vascular Interventions Poster Sessions
Abstract No. 307 Factors affecting the success of deep pelvic abscess drainage T. Ciftci1, O. Ergun1, U. Arslan2, D. Akinci1, O. Akhan1; 1 Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey; 2Department of Biostatistics, Hacettepe University, School of Medicine, Ankara, Turkey
Purpose: To evaluate the effects of factors on deep pelvic abscess drainage results retrospectively. Materials and Methods: Between 2002–2009 total 185 pelvic abscesses were treated in 163 patients under ultrasonograpy (US) and fluoroscopy (n⫽140) or computed tomography (CT, n⫽45) guidance via transabdominal, transvaginal, transrectal and transgluteal access routes. The effects of factors related with abscess (etiology, quantity, size, intrasturucture, microbiological content, presence of fistula), patient (age, sex, immune status, presence of malignancy, primary disease, being under antibiotic treatment before the procedure) and procedure (guidance method, access route, size of catheter) on clinical success, complications and catheter duration were statistically analyzed. Mann Whitney U and one way ANOVA tests were used as quantitative tests to compare two and three groups respectively whereas Fisher’s Exact and Likelihood Ratio Chi-square tests were used as qualitative tests to compare two and more than two groups respectively. Results: Technical and clinical success rates were 100% and 93.9% respectively. Fistulization was observed in 14 abscesses. Procedure related mortality or major complications were not observed. Minor complications such as catheter removal or break were determined in 7% of the patients. 10 patients (6.1%) were considered as clinical failure (recurrence n⫽7, mortality related sepsis n⫽2, necessity for surgery n⫽1). According to results fistulization extends catheter duration (P⬍0.05) and also decreases the clinical success rate (P⬍0.05). Presence of underlying disease affecting immunological condition of patient and presence of fungus infection in cavity extends catheter duration (P⬍0.05) without effecting clinical success (P⬎0.05). Transgluteal access route increases the rate of minor complications compared with other routes (P⬍0.05). Conclusion: The only factor affecting the clinical success rate in pelvic abscess treatment is the presence of fistula. Immune status of the patient and presence of fungal infection in the cavity extend the treatment period but they don’t affect clinical success.
Educational Exhibit
Abstract No. 308
Management of malignant distal biliary obstruction in cirrhotic liver: Transcystic duct approach S.E. Hegab; Radiodiagnosis and Intervention Radiology, Alexandria University, Alexandria, Egypt Learning Objectives: Distal extrahepatic biliary obstruction can be managed percutaneously when endoscopic therapy fails. However, transhepatic drainage may itself be unsuccessful especially in cirrhotic liver with non-dilated biliary radicals. In such patients, a transcholecystic approach was used to achieve biliary drainage with subsequent use of percutaneous cholecystostomy tract for biliary stent placement through transcystic approach. The purpose of this study was to evaluate the technical success of percutaneous transcholecystic placement of metallic stent for the treatment of malignant obstruction of the distal common bile duct in cirrhotic liver with non-dilated intrahepatic ducts. Background: This study included four patients with inoperable malignant obstructive lesion at the distal end of the common bile duct, three patients with pancreatic tumour and one patient with infiltrating duodenal carcinoma. In all patients, biliary drainage via transhepatic peripheral duct access or endoscopic retrograde biliary drainage was technically difficult. US guided percutaneous cholecystostomy was performed using 8F single step pig tail