Journal De Radiologie最新文献

Several interventional radiology procedures are available for the management of cancer pain. In this article, we will briefly review the different procedures and their value in the setting of cancer pain management under two main categories: indirect action (regional anesthesia from neurolysis) and direct action on the tumor. Percutaneous ablation of bone tumors: alcohol, laser, radiofrequency, microwaves, ultrasound, and cryoablation. Several indications have previously been validated, including thermal ablation of bone metastases with results superior to conventional therapies. Additional applications should be validated over the next few years.

Based on our preliminary experience with fluoroscopy-guided biopsy using a real-time 3D image fusion software, several biopsies may be performed in the interventional radiology suite as opposed to under CT guidance: percutaneous lung and bone biopsies are easily performed for lesions larger than 15 mm.

The local treatment of metastases is based on the natural history of the cancer and its modifications following medical treatment. Local treatment of metastases may be a component of the global treatment of the disease. Local treatment of metastases often is entertained for symptomatic relief. There is a theoretical analogy between surgery, the gold standard of local treatment, and more recent interventional radiology procedures. Local treatment may sometimes lead to discontinuation of medical therapy, either permanently or temporarily, and may at times provide prolonged complete response. The purpose of this article is to further the understanding of the place of local treatment in patients with metastatic solid tumors.

Percutaneous ablation of liver tumors was initially limited to patients that were not surgical candidates and with a limited number of relatively small liver lesions. Because of the diversification of techniques and technologies, percutaneous liver ablation has progressively been integrating to more and more complex therapeutic strategies available to a wider group of patients. Local knowledge and expertise with these techniques, largely dominated by radiofrequency ablation, often dictate the role of these techniques in the management of patients with liver tumors. We will review the clinical indications of percutaneous ablation techniques for liver tumors based on clinical considerations as well as ablation techniques.

The number of biopsy requests continuously increases over the years. Similarly, lesions that are not amenable to CT-guided biopsy are exceptional due to improved imaging guidance and technical advances. The needle tract should preferably go through fat, which is less painful and safer. The biopsy should be painless with the use of local anesthetics complemented by intravenous sedation. Blunt introducers and hydrodissection techniques create access to lesions without injury to vessels, bowel loops and fascias. The biopsy samples should be processed in accordance with the suspected diagnosis.

Chemoembolization of bone metastases is defined by the intraarterial perfusion of a chemotherapy agent followed by microparticles embolization to improve tissue impregnation. This technique increases the local concentration of the chemotherapy agent. Tumor response (stable or reduced tumor size) is achieved in 30–80% of cases with symptomatic relief in over 80% of cases. The indications, technical considerations, and effectiveness of this procedure will be reviewed.