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0211: Radiofrequency Thermal Ablation is More Effective Than Percutaneous Ethanol Injection in the Treatment of Functioning Thyroid Nodules
Abstracts undergoing change to a mature abscess. The final diagnosis of a LA is established with a ultrasound (or CT) guided puncture confirming pus. Treatment with a combination of iv antibiotics and percutaneous drainage (needle drainage or catheter drainage) carries a high success rate. Typically diagnostic and interventional images (ultrasound including US contrast and CT), case stories, and differential diagnoses will be presented.
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itored with fluoroscopy including x-ray contrast; however, the use of dilute US contrast has replaced x-ray in almost all our PCN procedures. In complicated cases (no hydronoprrosis), a puncture needle of fineneedle size may reduce the risk for bleeding, however, this technique requires initially a thin guidewire followed by dilatation and replacement with the stiff guidrwire. 0211
0208 Interventional Ultrasound: Cases That Went Wrong Michael Bachmann Nielsen, EFSUMB, Caduceus Speaker, Denmark The risk of major complications, defined as those complications inducing a significant worsening of the clinical condition of the patient and require substantial care (e. g., blood transfusion, resuscitation, surgery) with delayed hospital discharge or renewed hospitalization, has been reported to be between 0.05% to 0.23%. These figures are low and many especially young doctors seem to think that this means complications never happen. In the department where I work we perform about 2,000 interventional procedures each year ranging from simple punctures, drainages and biopsies to RF treatment often in patients with an increased risk of bleeding. Even though the risk of complications is low, the large number of procedures we perform unfortunately will cause major complications to happen every year. For obvious reasons I cannot give details of the patient stories in this abstract as there have been legal aspects following some of the complications. However, there will be presented cases with major complications and even deaths following biopsy, drainage, RF treatment, steroid injections and more. The cases are collected from me and my colleagues in Denmark during the last 4 years. All complications occurred after interventional procedures performed by highly experienced doctors (level 3). In retrospect some of the complications could maybe have been avoided had appropriate measures been taken. This is not a consecutive series where one can calculate the risk of complications; rather the complications presented were selected for this lecture because there may be a learning point in them. 0209 Ultrasound Guided Percutaneous Nephrostomy Torben Lorentzen, Copenhagen University Hospital at Herlev, Denmark Percutaneous nephrostomy (PCN) is usually a straightforward procedure, with a target success rate of 98% for dilated collecting systems and a major complication rate of 1%-4%. Optimizing patient preparation and imaging, and the use of appropriate equipment, increases technical success and minimizes complications. The main indications for PCN are ureteric obstruction with or without infection and stone disease. A urologic and/or oncologic evaluation of the patient should be performed before PCN since alternatives as ureteric stent or no treatment might be considered in some cases. In easy cases (significant hydronophrosis, good imaging on US, and a puncture route less than 6 cm) I prefer to perform PCN with a direct puncture (single step technique) with the 7 Fr trocart pigtail catheter. A needle guide mounted on the transducer is helpful; however, more skilled US interventionalists might prefer the free-hand technique. For internal fixation a string-lock mechanism is used, the external fixation is established with a dedicated drainfix plaster. In difficult cases including cases without hydronephrosis, a two step technique (Seldinger) is used. The calyx is punctured with an 18 gauge needle; a stiff guidewire (with soft tip) is inserted and finally, the catheter is introduced over the guidewire. The procedure can be mon-
Radiofrequency Thermal Ablation is More Effective Than Percutaneous Ethanol Injection in the Treatment of Functioning Thyroid Nodules Antongiulio Faggiano, Federico II University of Naples, Italy, Italy Stefano Spiezia, S. Maria del Popolo degli Incurabili Hospital, Naples, Italy, Italy Roberto Garberoglio, Mauriziano Hospital, Turin, Italy, Italy Valeria Ramundo, Federico II University of Naples, Italy, Italy Angelo P Assanti, S. Maria del Popolo degli Incurabili Hospital, Naples, Italy, Italy Paolo P Limone, Mauriziano Hospital, Turin, Italy, Italy Gaetano Lombardi, Federico II University of Naples, Italy, Italy Annamaria Colao, Federico II University of Naples, Italy, Italy Objectives: Percutaneous radiofrequency thermal ablation (RTA) has been recently shown to reduce significantly the volume of thyroid nodules (TNs) and related symptoms. Instead, the effectiveness of percutaneous ethanol injection (PEI) appears to be limited to patients with small and predominantly cystic nodules. The objective of this study is to compare the effectiveness of the RTA and PEI in patients with solid hyperfunctioning TNs. Methods: Thirty patients with hyperfunctioning, cytological benign TNs (18 toxic TN and 12 pre-toxic TN), were subjected to local ablative treatment. Patients were separated into two groups comparable in age, sex, volume and ultrasound characteristics of TNs: fifteen were treated with RTA (RITA © StarBurst Talon hook-umbrella needle inserted under ultrasonographic real time guide) and fifteen other patients were treated with PEI. Results: The reduction in the volume of TNs was significantly higher in patients treated with RTA than in those treated with PEI (p⬍0.01). The average reduction rate of TNs as compared to baseline was 51.5⫹/-2.7% (range 22-77%) in patients treated with RTA and 27.5⫹/4.8% (range 10-44%) in those treated with PEI. The hyperthyroidism improved in both groups but the number of patients who showed eutiroidism after treatment was significantly higher in the RTA than in the PEI group (p⬍0.05). Conclusions: The RTA seems to show greater effectiveness of PEI in reducing nodular volume and controlling hyperthyroidism in patients with thyroid nodules. The RTA is proposed as a method of great interest and potential development in percutaneous ablative treatment of toxic and pre-toxic nodular goiter. 0212 Ultrasound-Guided Percutaneous Laser Ablation in Patients with Benign Thyroid Nodules Mikhail S Mogutov, Yaroslavl Railway Clinic, Russia Alexander N Sencha, Yaroslavl Railway Clinic, Russia Yury N Patrunov, Yaroslavl Railway Clinic, Russia Purpose: To define indications and the efficacy of percutaneous laser ablation (PLA). Materials and Methods: US-guided PLA was performed in 566 thyroid nodules (1-6 sessions with output power 2.5-4W for 42-620 seconds). Follow-up period was up to 6 years. Results: The best results were achieved in solitary solid nodules less than 2.0 cm in size with sufficiently homogenous echostructure, low or
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itored with fluoroscopy including x-ray contrast; however, the use of dilute US contrast has replaced x-ray in almost all our PCN procedures. In complicated cases (no hydronoprrosis), a puncture needle of fineneedle size may reduce the risk for bleeding, however, this technique requires initially a thin guidewire followed by dilatation and replacement with the stiff guidrwire. 0211
0208 Interventional Ultrasound: Cases That Went Wrong Michael Bachmann Nielsen, EFSUMB, Caduceus Speaker, Denmark The risk of major complications, defined as those complications inducing a significant worsening of the clinical condition of the patient and require substantial care (e. g., blood transfusion, resuscitation, surgery) with delayed hospital discharge or renewed hospitalization, has been reported to be between 0.05% to 0.23%. These figures are low and many especially young doctors seem to think that this means complications never happen. In the department where I work we perform about 2,000 interventional procedures each year ranging from simple punctures, drainages and biopsies to RF treatment often in patients with an increased risk of bleeding. Even though the risk of complications is low, the large number of procedures we perform unfortunately will cause major complications to happen every year. For obvious reasons I cannot give details of the patient stories in this abstract as there have been legal aspects following some of the complications. However, there will be presented cases with major complications and even deaths following biopsy, drainage, RF treatment, steroid injections and more. The cases are collected from me and my colleagues in Denmark during the last 4 years. All complications occurred after interventional procedures performed by highly experienced doctors (level 3). In retrospect some of the complications could maybe have been avoided had appropriate measures been taken. This is not a consecutive series where one can calculate the risk of complications; rather the complications presented were selected for this lecture because there may be a learning point in them. 0209 Ultrasound Guided Percutaneous Nephrostomy Torben Lorentzen, Copenhagen University Hospital at Herlev, Denmark Percutaneous nephrostomy (PCN) is usually a straightforward procedure, with a target success rate of 98% for dilated collecting systems and a major complication rate of 1%-4%. Optimizing patient preparation and imaging, and the use of appropriate equipment, increases technical success and minimizes complications. The main indications for PCN are ureteric obstruction with or without infection and stone disease. A urologic and/or oncologic evaluation of the patient should be performed before PCN since alternatives as ureteric stent or no treatment might be considered in some cases. In easy cases (significant hydronophrosis, good imaging on US, and a puncture route less than 6 cm) I prefer to perform PCN with a direct puncture (single step technique) with the 7 Fr trocart pigtail catheter. A needle guide mounted on the transducer is helpful; however, more skilled US interventionalists might prefer the free-hand technique. For internal fixation a string-lock mechanism is used, the external fixation is established with a dedicated drainfix plaster. In difficult cases including cases without hydronephrosis, a two step technique (Seldinger) is used. The calyx is punctured with an 18 gauge needle; a stiff guidewire (with soft tip) is inserted and finally, the catheter is introduced over the guidewire. The procedure can be mon-
Radiofrequency Thermal Ablation is More Effective Than Percutaneous Ethanol Injection in the Treatment of Functioning Thyroid Nodules Antongiulio Faggiano, Federico II University of Naples, Italy, Italy Stefano Spiezia, S. Maria del Popolo degli Incurabili Hospital, Naples, Italy, Italy Roberto Garberoglio, Mauriziano Hospital, Turin, Italy, Italy Valeria Ramundo, Federico II University of Naples, Italy, Italy Angelo P Assanti, S. Maria del Popolo degli Incurabili Hospital, Naples, Italy, Italy Paolo P Limone, Mauriziano Hospital, Turin, Italy, Italy Gaetano Lombardi, Federico II University of Naples, Italy, Italy Annamaria Colao, Federico II University of Naples, Italy, Italy Objectives: Percutaneous radiofrequency thermal ablation (RTA) has been recently shown to reduce significantly the volume of thyroid nodules (TNs) and related symptoms. Instead, the effectiveness of percutaneous ethanol injection (PEI) appears to be limited to patients with small and predominantly cystic nodules. The objective of this study is to compare the effectiveness of the RTA and PEI in patients with solid hyperfunctioning TNs. Methods: Thirty patients with hyperfunctioning, cytological benign TNs (18 toxic TN and 12 pre-toxic TN), were subjected to local ablative treatment. Patients were separated into two groups comparable in age, sex, volume and ultrasound characteristics of TNs: fifteen were treated with RTA (RITA © StarBurst Talon hook-umbrella needle inserted under ultrasonographic real time guide) and fifteen other patients were treated with PEI. Results: The reduction in the volume of TNs was significantly higher in patients treated with RTA than in those treated with PEI (p⬍0.01). The average reduction rate of TNs as compared to baseline was 51.5⫹/-2.7% (range 22-77%) in patients treated with RTA and 27.5⫹/4.8% (range 10-44%) in those treated with PEI. The hyperthyroidism improved in both groups but the number of patients who showed eutiroidism after treatment was significantly higher in the RTA than in the PEI group (p⬍0.05). Conclusions: The RTA seems to show greater effectiveness of PEI in reducing nodular volume and controlling hyperthyroidism in patients with thyroid nodules. The RTA is proposed as a method of great interest and potential development in percutaneous ablative treatment of toxic and pre-toxic nodular goiter. 0212 Ultrasound-Guided Percutaneous Laser Ablation in Patients with Benign Thyroid Nodules Mikhail S Mogutov, Yaroslavl Railway Clinic, Russia Alexander N Sencha, Yaroslavl Railway Clinic, Russia Yury N Patrunov, Yaroslavl Railway Clinic, Russia Purpose: To define indications and the efficacy of percutaneous laser ablation (PLA). Materials and Methods: US-guided PLA was performed in 566 thyroid nodules (1-6 sessions with output power 2.5-4W for 42-620 seconds). Follow-up period was up to 6 years. Results: The best results were achieved in solitary solid nodules less than 2.0 cm in size with sufficiently homogenous echostructure, low or