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Do no harm: advanced protective techniques during image-guided percutaneous thermal ablation of renal tumors
JVIR
’
Posters and Exhibits
S243
Learning Objectives: 1) Review basic principles of percutaneous thermal ablation, specifically as it relates to the treatment of vertebral body metastatic disease. 2) Share institutional experience in percutaneous thermal ablation of vertebral body metastases using both microwave and radiofrequency ablation. Background: Metastatic disease to the spine causes significant pain in 75-90% of patients with advanced stage cancer. Quality of life is significantly affected and conventional treatment strategies with analgesia, chemo and radiopharmaceutical therapy, and surgery have more recently been supplemented by percutaneous ablation and augmentation. Isolated cementoplasty, radiofrequency ablation, and combined RF ablation, cementoplasty and cryotherapy are well described strategies with recent feasibility studies on microwave ablation being reported. Clinical Findings/Procedure Details: This exhibit will report our institution’s experience in treating vertebral body metastatic disease with thermal ablation via both radiofrequency (RF) and microwave (MW) energy, in conjunction with kyphoplasty. Retrospective review over the past 1 year includes 14 patients in which a total of 16 ablations were performed, spanning from T3 to L5. 13 RF ablations and 3 MW ablations were performed. Primary tumors included hepatocellular, prostate, colorectal, renal, multiple myeloma, bladder, and lung (both small cell and NSCLC). No complications related to ablation with augmentation have occurred to date. All patients experienced relief of pain. This exhibit will highlight the techniques and parameters used in various patients, as well as imaging and clinical follow-up. Conclusions: Thermal ablation, via both microwave and radiofrequency ablation, is a safe and effective adjunct to structural vertebral body augmentation in the treatment of metastatic disease to the spine. References 1. Smith HS. Painful osseous metastases. Pain Phys 2011; 14:E373–E403. 2. Kastler A, Alnassan H, Aubrey S, Kastler B. Microwave thermal ablation of spinal metastatic bone tumors. JVIR 2014; 9:1470–1475. 3. Anchala P, Winston I, Hillen T, et al. Treatment of metastatic spinal lesions with a navigational bipolar radiofrequency ablation device: a multicenter retrospective study. Pain Phys 2014; 17:317–327. 4. Wallace A, Greenwood T, Jennings J. Radiofrequency ablation and vertebral augmentation for palliation of painful spinal metastases. J Neurooncol 2015; 124:111–118. 5. Sandri A, Carbognin G, Regis D, et al. Combined radiofrequency and kyphoplasty in painful osteolytic metastases to vertebral bodies. Radiol med 2010; 115:261–271.
Educational Exhibit
Abstract No. 550
K. Patel1, M. Le2, H. YU3, B. Achakzai, M.D4, V. Paidpally2, M. Jaber5, R. Kakos6, S. Danier7, K. Shah1, M. Harvill6, J. Critchfield8, W. Saad9; 1Wayne State University, Detroit, MI; 2Detroit Medical Center/Wayne State University, Detroit, MI; 3DETROIT MEDICAL CENTER, Novi, MI; 4Henry Ford Hospital, Detroit, MI; 5Dearborn Heights, MI; 6Harper University Hospital, Detroit, MI;
Grosse Pointe Shores, MI; 8Troy, MI; 9University of Michigan, Ann Arbor, Michigan Learning Objectives: In this exhibit, we discuss the physical properties of different ablative technologies and their associated thermal effects. Specifically, we describe the principles governing radiofrequency/microwave/cryo ablation. We illustrate various protective measures utilized in preventing damage to surrounding tissues when performing an ablation for kidney tumors. Background: Percutaneous thermal ablation is an effective, minimally invasive nephron-sparing treatment option for small solid renal tumors. Although the procedure is safe, thermally induced damage to structures adjacent to a targeted lesion (nontarget damage) remains a concern. Depending on tumor location, the major complications include injury to nearby organs (stomach, pancreas, bowel), strictures of both the ureter and collecting system, neuromuscular injury (psoas lumbar plexus), and damage to the diaphragm/lung. Interventional radiologists who perform percutaneous kidney ablation should be familiar with these protective techniques in order to achieve a successful outcome with the lowest complication rate. Clinical Findings/Procedure Details: We will describe in depth and illustrate different techniques that can be used to keep surrounding susceptible structures at bay during a kidney ablation. We will list the necessary steps and technical considerations for the following: hydrodissection, gasinsufflation, balloon interposition, electrode torquing, pyeloperfusion, iatrogenic pneumothorax. In addition, we will highlight the advantages and potential drawbacks pertaining to each technique. Conclusions: Percutaneous thermal ablation has emerged as an effective treatment method for eradication of small renal tumors. However, the most common complication of the procedure is iatrogenic thermal damage of surrounding sensitive structures. Thorough knowledge of the available protective techniques is necessary for a safe and successful procedural outcome.
Educational Exhibit
Abstract No. 551
The glass chameleon—peliosis hepatis: a diagnostic challenge for the radiologist and a danger for the interventionalist Y. Zhang, A. Tong, S. Maddineni; Westchester Medical Center, Valhalla, NY Learning Objectives: 1. Present case examples of peliosis hepatis (PH) with imaging features and pathology correlation. 2. Discuss the diagnostic challenges and the importance of multidisciplinary approach in establishing the correct diagnosis. 3. Review the indications and outcomes of transugular liver biopsy and compare to that of percutaneous liver biopsy. 4. Using PH as an example to demonstrate the importance and challenges in selecting the appropriate interventional technique. Background: PH is a rare benign vascular condition, which is characterized by sinusoidal dilatation and multiple blood-filled cysts distributed throughout the liver. The pathogenesis of this condition is unclear, but is possibly secondary to congenital or
Posters and Exhibits
Do no harm: advanced protective techniques during image-guided percutaneous thermal ablation of renal tumors
7
’
Posters and Exhibits
S243
Learning Objectives: 1) Review basic principles of percutaneous thermal ablation, specifically as it relates to the treatment of vertebral body metastatic disease. 2) Share institutional experience in percutaneous thermal ablation of vertebral body metastases using both microwave and radiofrequency ablation. Background: Metastatic disease to the spine causes significant pain in 75-90% of patients with advanced stage cancer. Quality of life is significantly affected and conventional treatment strategies with analgesia, chemo and radiopharmaceutical therapy, and surgery have more recently been supplemented by percutaneous ablation and augmentation. Isolated cementoplasty, radiofrequency ablation, and combined RF ablation, cementoplasty and cryotherapy are well described strategies with recent feasibility studies on microwave ablation being reported. Clinical Findings/Procedure Details: This exhibit will report our institution’s experience in treating vertebral body metastatic disease with thermal ablation via both radiofrequency (RF) and microwave (MW) energy, in conjunction with kyphoplasty. Retrospective review over the past 1 year includes 14 patients in which a total of 16 ablations were performed, spanning from T3 to L5. 13 RF ablations and 3 MW ablations were performed. Primary tumors included hepatocellular, prostate, colorectal, renal, multiple myeloma, bladder, and lung (both small cell and NSCLC). No complications related to ablation with augmentation have occurred to date. All patients experienced relief of pain. This exhibit will highlight the techniques and parameters used in various patients, as well as imaging and clinical follow-up. Conclusions: Thermal ablation, via both microwave and radiofrequency ablation, is a safe and effective adjunct to structural vertebral body augmentation in the treatment of metastatic disease to the spine. References 1. Smith HS. Painful osseous metastases. Pain Phys 2011; 14:E373–E403. 2. Kastler A, Alnassan H, Aubrey S, Kastler B. Microwave thermal ablation of spinal metastatic bone tumors. JVIR 2014; 9:1470–1475. 3. Anchala P, Winston I, Hillen T, et al. Treatment of metastatic spinal lesions with a navigational bipolar radiofrequency ablation device: a multicenter retrospective study. Pain Phys 2014; 17:317–327. 4. Wallace A, Greenwood T, Jennings J. Radiofrequency ablation and vertebral augmentation for palliation of painful spinal metastases. J Neurooncol 2015; 124:111–118. 5. Sandri A, Carbognin G, Regis D, et al. Combined radiofrequency and kyphoplasty in painful osteolytic metastases to vertebral bodies. Radiol med 2010; 115:261–271.
Educational Exhibit
Abstract No. 550
K. Patel1, M. Le2, H. YU3, B. Achakzai, M.D4, V. Paidpally2, M. Jaber5, R. Kakos6, S. Danier7, K. Shah1, M. Harvill6, J. Critchfield8, W. Saad9; 1Wayne State University, Detroit, MI; 2Detroit Medical Center/Wayne State University, Detroit, MI; 3DETROIT MEDICAL CENTER, Novi, MI; 4Henry Ford Hospital, Detroit, MI; 5Dearborn Heights, MI; 6Harper University Hospital, Detroit, MI;
Grosse Pointe Shores, MI; 8Troy, MI; 9University of Michigan, Ann Arbor, Michigan Learning Objectives: In this exhibit, we discuss the physical properties of different ablative technologies and their associated thermal effects. Specifically, we describe the principles governing radiofrequency/microwave/cryo ablation. We illustrate various protective measures utilized in preventing damage to surrounding tissues when performing an ablation for kidney tumors. Background: Percutaneous thermal ablation is an effective, minimally invasive nephron-sparing treatment option for small solid renal tumors. Although the procedure is safe, thermally induced damage to structures adjacent to a targeted lesion (nontarget damage) remains a concern. Depending on tumor location, the major complications include injury to nearby organs (stomach, pancreas, bowel), strictures of both the ureter and collecting system, neuromuscular injury (psoas lumbar plexus), and damage to the diaphragm/lung. Interventional radiologists who perform percutaneous kidney ablation should be familiar with these protective techniques in order to achieve a successful outcome with the lowest complication rate. Clinical Findings/Procedure Details: We will describe in depth and illustrate different techniques that can be used to keep surrounding susceptible structures at bay during a kidney ablation. We will list the necessary steps and technical considerations for the following: hydrodissection, gasinsufflation, balloon interposition, electrode torquing, pyeloperfusion, iatrogenic pneumothorax. In addition, we will highlight the advantages and potential drawbacks pertaining to each technique. Conclusions: Percutaneous thermal ablation has emerged as an effective treatment method for eradication of small renal tumors. However, the most common complication of the procedure is iatrogenic thermal damage of surrounding sensitive structures. Thorough knowledge of the available protective techniques is necessary for a safe and successful procedural outcome.
Educational Exhibit
Abstract No. 551
The glass chameleon—peliosis hepatis: a diagnostic challenge for the radiologist and a danger for the interventionalist Y. Zhang, A. Tong, S. Maddineni; Westchester Medical Center, Valhalla, NY Learning Objectives: 1. Present case examples of peliosis hepatis (PH) with imaging features and pathology correlation. 2. Discuss the diagnostic challenges and the importance of multidisciplinary approach in establishing the correct diagnosis. 3. Review the indications and outcomes of transugular liver biopsy and compare to that of percutaneous liver biopsy. 4. Using PH as an example to demonstrate the importance and challenges in selecting the appropriate interventional technique. Background: PH is a rare benign vascular condition, which is characterized by sinusoidal dilatation and multiple blood-filled cysts distributed throughout the liver. The pathogenesis of this condition is unclear, but is possibly secondary to congenital or
Posters and Exhibits
Do no harm: advanced protective techniques during image-guided percutaneous thermal ablation of renal tumors
7