Seminars in Interventional Radiology最新文献

Over the past two decades, magnetic resonance imaging (MRI) has become the mainstay for lymphatic imaging in pediatric patients suffering from lymphatic disorders caused by congenital or acquired causes. Pediatric patients, especially those born with complex congenital heart disease, status post single ventricle palliation increasingly constitute the largest group of patients presenting with lymphatic dysfunction. Heavily T2-weighted and 3D-balanced steady-state free precession are complementary MRI sequences used for noninvasive assessment of the central lymphatic anatomy as well as distribution of lymphatic fluid in body cavities, lymphatic cysts, and lymphatic malformations. These sequences are, however, limited in their ability to visualize smaller lymphatics, to differentiate lymphatics from other fluid-filled structures, or to provide sequential flow information. This limitation is overcome by administering a gadolinium-based contrast agent into a lymph node, lymphatic vessel, or interstitial tissue with simultaneous image acquisition, a technique called dynamic contrast-enhanced magnetic resonance lymphangiography. This imaging is invasive but critical for evaluating lymphatic flow and identifying potential targets for lymphatic intervention. Medical therapy, along with traditional transcatheter or surgical approaches to address the underlying cause of the lymphatic disorder, remains the first-line approach, while lymphatic interventions are reserved for patients who have failed these therapies.

Intra-abdominal solid organ injuries (SOI) represent a common and potentially life-threatening consequence in the traumatically injured patient. Advances in interventional radiology (IR) endovascular techniques have reformed the surgical management of these injuries into a multidisciplinary approach. The choice between endovascular and surgical management depends largely on the patient's hemodynamic status, injury grade, and risk of complications. Although individualized, surgery is reserved for most patients who are hemodynamically unstable, have peritonitis, hollow viscus injury, or are refractory to IR intervention. IR intervention can be attempted in cases of active extravasation or SOI with high-risk imaging features. However, in complex liver trauma, combined management with surgery and IR has been shown to reduce mortality. This review synthesizes recent advances and evidence-based practices for managing SOI, emphasizing the role of IR as an adjunct to surgical management and complication resolution.

Curettage with grafting and open surgical resection used to be the mainstay for treating bone cysts and benign bone tumors in children; however, given the morbidity and high recurrence rates associated with open surgical techniques, minimally invasive approaches have become primary therapy in many clinical instances, which the field of interventional radiology is pioneering. This manuscript specifically addresses minimally invasive, percutaneous interventions for unicameral bone cysts, aneurysmal bone cysts, osteoid osteoma, and chondroblastoma in children.

Management of portal hypertension (PHTN) in pediatric patients presents challenges due to the smaller anatomy and a lack of standardized protocols. While evidence for endovascular management of ectopic varices, maintenance of surgical shunts, portal venous recanalization, and percutaneous portosystemic shunt creation in children grows, adaptation requires specialized techniques and equipment. This review explores the etiologies of pediatric PHTN, including Budd-Chiari syndrome, congenital anomalies, extrahepatic portal vein obstruction, and transplant vascular occlusions, and examines radiologic interventions to address these conditions. Management strategies are divided into relieving the primary cause of PHTN at the level of portal obstruction and managing the secondary effects of PHTN. For each category, the discussion focuses on device selection, postprocedural care, imaging surveillance, and management of pediatric scenarios.

The management of pelvic trauma has undergone a transformation with the advent of interventional radiologic techniques, particularly embolization procedures. Embolization allows for control of pelvic hemorrhage, utilizing real-time imaging to identify and treat injured vessels, thereby stabilizing patients and reducing the need for invasive surgical procedures. Through advanced imaging and evolving technologies, interventional radiologists continue to refine the management of pelvic trauma and improve clinical outcomes. This review describes the background and current endovascular management of pelvic trauma by IR.

The genitourinary tract is commonly injured in blunt and penetrating trauma. Improvements in interventional radiology (IR) techniques increasingly allow for minimally invasive treatment options for a range of genitourinary injuries. Through ongoing advances in image-guided techniques, IR physicians continue to refine genitourinary trauma management, improving treatment efficacy and safety. This review describes the background, current practices, and future directions for IR-guided genitourinary trauma management.

Vascular malformations are congenital abnormalities arising from dysregulated angiogenesis, often due to gain-of-function somatic mutations. Extracranial disease involvement can cause significant pain, disfigurement, and functional limitations. Conventional sclerosing agents such as ethanol, sodium tetradecyl sulfate, and doxycycline are effective in treating the majority of slow-flow vascular malformations. However, these sclerosants have limited efficacy in lesions with significant lipomatous or stromal components and can be associated with significant local toxicity, especially if extravasated. The wider adoption of bleomycin and new interventional techniques such as bleomycin electrosclerotherapy using reversible electroporation and percutaneous thermal ablative modalities has shifted treatment paradigms for challenging cases which are refractory to conventional sclerosants. This article aims to provide an overview of these recent advances in interventional techniques and to highlight the importance of the integration of personalized precision medicine in the multidisciplinary care of children with extracranial vascular malformations.

Pediatric chronic pain is a significant problem that is often underreported and therefore not always adequately addressed. Causes include anatomic variants, trauma, local inflammation, and malignancy. Nerve blocks and cryoneurolysis can aid as an adjunct to pain management for these patients and significantly improve their quality of life. This article will describe specific procedures in which interventional radiology can aid in several specific procedures for pediatric pain management: splanchnic cryoneurolysis, sphenopalatine ganglion nerve block/cryoneurolysis, inferior alveolar nerve block, intercostal cryoneurolysis, and cryoablation of painful bone metastases, notably in the setting of metastatic sarcoma.