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Interactive near real-time high resolution imaging for open MR guided interventions using zoom MRI at 1.0 Tesla - initial experience
S110
’
Wednesday
Scientific Session
(p¼0.000; p¼0.000). There were no procedure related complications. Conclusion: CT guided percutaneous cryoablation may represent a safe and efficacious option for patients with refractory pudendal neuralgia.
8:36 AM
Abstract No. 235
Percutaneous stabilization of metastatic disease in the acetabulum
WEDNESDAY: Scientific Sessions
M. Hartung, J.C. Neilson, D.M. King, S.B. White, S.M. Tutton; Radiology, Medical College of Wisconsin, Milwaukee, WI Purpose: Patients with periacetabular bone destruction and impending or pathologic fractures from metastatic cancer have limited treatment options. Complex acetabular reconstruction can improve mobility, but has a high rate of complications and post-operative morbidity, and can delay chemotherapy and radiation.1 Through the collaboration of orthopedic oncologists and interventional radiologists, we have developed an alternative, minimally invasive approach to stabilize the pelvis. Materials and Methods: Ten patients underwent percutaneous screw fixation and polymethyl methacrylate augmentation for impending or non-displaced pathologic fractures of the acetabulum due to metastatic disease between 11/2011-5/2013. Ablation was performed when appropriate. Medical records were reviewed for hospital course, ability to receive chemotherapy and radiation, pain, and functional scores before and after surgery based on the Musculoskeletal Tumor Society (MSTS) scoring system. Results: Ten patients with a median age of 57.5 made up our cohort. We had a 100% technical success rate and no major complications. Seven patients received conscious sedation, and 3 general anesthesia. Postoperatively, 9 patients were weightbearing as tolerated, and 1 patient was toe-touch weight bearing. Five patients were discharged within 24 hours of surgery, with a mean hospital stay of 4 days. Nine patients could immediately receive chemotherapy and radiation. The mean preoperative and postoperative MSTS scores were 0.3 vs. 2.7 for pain (5 is normal), and 7.1 vs. 15.2 for the total functional score (30 is normal). Pain and mobility improved for all patients. Conclusion: Percutaneous acetabular stabilization improves the pain, mobility, and quality of life in patients with painful metastatic disease and limited life expectancy. It carries a low risk of complications and allows for earlier chemotherapy and radiation. Therefore, patients with painful impending or pathologic pelvic fractures should be considered for minimally invasive stabilization through our multidisciplinary approach. Reference 1. Jaiswal PK, Aston WJ, Grimer RJ, et al. Peri-acetabular resection and endoprosthesis for tumours of the acetabulum. J Bone Joint Surg Br 2008; 90(9):1222–1227.
8:45 AM
’
JVIR
Abstract No. 236
’ FEATURED ABSTRACT Interactive near real-time high resolution imaging for open MR guided interventions using zoom MRI at 1.0 Tesla - initial experience M.R. Makowski1, M. Jonczyk1, F. Streitparth1, F.V. Guettler2, H. Rathke1, B. Suttmeyer1, L. Albrecht1, U. Teichgraeber2, B. Hamm1, M. de Bucourt1; 1 Department of Radiology, Charité – University Medicine Berlin, Berlin, Germany; 2Department of Radiology, Jena University, Jena, Germany Purpose: Different techniques for MR-guided interventions were introduced in recent years. Appropriate sequence design is crucial since high spatial resolution often compels lower temporal resolution. The purpose of this study was to evaluate the value of accelerated ZOOM-based imaging sequences for lumbar interventions. Materials and Methods: 31 interventions (periradicular, facet joint, epidural infiltrations and discography) were performed in 24 patients (10 women, 14 men, age 43⫾13.3). SNR and CNR of pre- (T2W), peri- (PDW) and post-interventional (STIR) imaging was evaluated. Needle artifacts were assessed by direct measurement as well as with parallel and perpendicular needle profiles. Puncture times were compared to similar interventions previously performed. Results: No significant differences comparing the signal intensities (Standard/ZOOM: 152.0/151.6; p¼0.136) and CNR values (2.0/4.0; p¼0.487) were measured in T2W sequences. The needle artifact’s signal intensity is comparable (648.1/747.5; p¼0.172) in interventional imaging. Standard interventional (fat-needle: 43.8/23.4; po0.001; muscle-needle: 6.2/2.4; po0.001) and STIR sequences (43.3/13.9; p¼0.010) showed a higher CNR compared to corresponding ZOOM sequences. Needle artifacts were larger in ZOOM (2.4 mm/2.9 mm; p¼0.005). Whereas the profiles revealed that the new sequence delivers overall more signal intensity. The turning points of both profiles remain comparable. ZOOM reduced intervention times significantly (329.1s/228.5s; p¼0.026). Conclusion: ZOOM imaging is a feasible interactive sequence for lumbar interventions. It ameliorates the tradeoff between image quality and temporal resolution. Moreover, the sequence design reduces intervention times significantly. References 1. Sacks D, et al. Society of Interventional Radiology clinical practice guidelines. JVIR 2003 Sep; 14(9 Pt 2):S199–S202. 2. de Bucourt M, et al. Minimally invasive magnetic resonance imaging-guided free-hand aspiration of symptomatic nerve route compressing lumbosacral cysts using a 1.0-Tesla open magnetic resonance imaging system. CVIR 2012 Feb; 35(1):154–160. 3. Hickey R, et al. Cancer concepts and principles: primer for the interventional oncologist-part I. JVIR 2013 Aug; 24(8):1157–1164.
’
Wednesday
Scientific Session
(p¼0.000; p¼0.000). There were no procedure related complications. Conclusion: CT guided percutaneous cryoablation may represent a safe and efficacious option for patients with refractory pudendal neuralgia.
8:36 AM
Abstract No. 235
Percutaneous stabilization of metastatic disease in the acetabulum
WEDNESDAY: Scientific Sessions
M. Hartung, J.C. Neilson, D.M. King, S.B. White, S.M. Tutton; Radiology, Medical College of Wisconsin, Milwaukee, WI Purpose: Patients with periacetabular bone destruction and impending or pathologic fractures from metastatic cancer have limited treatment options. Complex acetabular reconstruction can improve mobility, but has a high rate of complications and post-operative morbidity, and can delay chemotherapy and radiation.1 Through the collaboration of orthopedic oncologists and interventional radiologists, we have developed an alternative, minimally invasive approach to stabilize the pelvis. Materials and Methods: Ten patients underwent percutaneous screw fixation and polymethyl methacrylate augmentation for impending or non-displaced pathologic fractures of the acetabulum due to metastatic disease between 11/2011-5/2013. Ablation was performed when appropriate. Medical records were reviewed for hospital course, ability to receive chemotherapy and radiation, pain, and functional scores before and after surgery based on the Musculoskeletal Tumor Society (MSTS) scoring system. Results: Ten patients with a median age of 57.5 made up our cohort. We had a 100% technical success rate and no major complications. Seven patients received conscious sedation, and 3 general anesthesia. Postoperatively, 9 patients were weightbearing as tolerated, and 1 patient was toe-touch weight bearing. Five patients were discharged within 24 hours of surgery, with a mean hospital stay of 4 days. Nine patients could immediately receive chemotherapy and radiation. The mean preoperative and postoperative MSTS scores were 0.3 vs. 2.7 for pain (5 is normal), and 7.1 vs. 15.2 for the total functional score (30 is normal). Pain and mobility improved for all patients. Conclusion: Percutaneous acetabular stabilization improves the pain, mobility, and quality of life in patients with painful metastatic disease and limited life expectancy. It carries a low risk of complications and allows for earlier chemotherapy and radiation. Therefore, patients with painful impending or pathologic pelvic fractures should be considered for minimally invasive stabilization through our multidisciplinary approach. Reference 1. Jaiswal PK, Aston WJ, Grimer RJ, et al. Peri-acetabular resection and endoprosthesis for tumours of the acetabulum. J Bone Joint Surg Br 2008; 90(9):1222–1227.
8:45 AM
’
JVIR
Abstract No. 236
’ FEATURED ABSTRACT Interactive near real-time high resolution imaging for open MR guided interventions using zoom MRI at 1.0 Tesla - initial experience M.R. Makowski1, M. Jonczyk1, F. Streitparth1, F.V. Guettler2, H. Rathke1, B. Suttmeyer1, L. Albrecht1, U. Teichgraeber2, B. Hamm1, M. de Bucourt1; 1 Department of Radiology, Charité – University Medicine Berlin, Berlin, Germany; 2Department of Radiology, Jena University, Jena, Germany Purpose: Different techniques for MR-guided interventions were introduced in recent years. Appropriate sequence design is crucial since high spatial resolution often compels lower temporal resolution. The purpose of this study was to evaluate the value of accelerated ZOOM-based imaging sequences for lumbar interventions. Materials and Methods: 31 interventions (periradicular, facet joint, epidural infiltrations and discography) were performed in 24 patients (10 women, 14 men, age 43⫾13.3). SNR and CNR of pre- (T2W), peri- (PDW) and post-interventional (STIR) imaging was evaluated. Needle artifacts were assessed by direct measurement as well as with parallel and perpendicular needle profiles. Puncture times were compared to similar interventions previously performed. Results: No significant differences comparing the signal intensities (Standard/ZOOM: 152.0/151.6; p¼0.136) and CNR values (2.0/4.0; p¼0.487) were measured in T2W sequences. The needle artifact’s signal intensity is comparable (648.1/747.5; p¼0.172) in interventional imaging. Standard interventional (fat-needle: 43.8/23.4; po0.001; muscle-needle: 6.2/2.4; po0.001) and STIR sequences (43.3/13.9; p¼0.010) showed a higher CNR compared to corresponding ZOOM sequences. Needle artifacts were larger in ZOOM (2.4 mm/2.9 mm; p¼0.005). Whereas the profiles revealed that the new sequence delivers overall more signal intensity. The turning points of both profiles remain comparable. ZOOM reduced intervention times significantly (329.1s/228.5s; p¼0.026). Conclusion: ZOOM imaging is a feasible interactive sequence for lumbar interventions. It ameliorates the tradeoff between image quality and temporal resolution. Moreover, the sequence design reduces intervention times significantly. References 1. Sacks D, et al. Society of Interventional Radiology clinical practice guidelines. JVIR 2003 Sep; 14(9 Pt 2):S199–S202. 2. de Bucourt M, et al. Minimally invasive magnetic resonance imaging-guided free-hand aspiration of symptomatic nerve route compressing lumbosacral cysts using a 1.0-Tesla open magnetic resonance imaging system. CVIR 2012 Feb; 35(1):154–160. 3. Hickey R, et al. Cancer concepts and principles: primer for the interventional oncologist-part I. JVIR 2013 Aug; 24(8):1157–1164.