Techniques in Vascular and Interventional Radiology最新文献

Autonomously functioning thyroid nodules (AFTN) are a common cause of hyperthyroid symptoms. While hemithyroidectomy or radioactive iodine ablation have historically been used to treat AFTNs, percutaneous thyroid radiofrequency ablation (RFA) is emerging as a promising option for outpatient therapy. The technique is compared to medical therapy, radioactive iodine therapy, and surgery, with an emphasis on technical differences in the ablation procedure for AFTN vs other benign thyroid nodules.

In addition to the basic techniques used in radiofrequency ablation of thyroid nodules, a variety of more advanced techniques have been developed. To address hyper-vascular nodules, vascular ablative techniques have been described. Protective hydro-dissection can be used around the carotid artery and the trachea to improve safety. Rescue hydro dissection can be used to reverse nerve injury. Additionally, several new ablation devices show promise at increasing efficacy and safety. These techniques and devices will be reviewed to provide an understanding of these advanced techniques and novel devices.

While radiofrequency ablation (RFA) for the treatment of symptomatic thyroid nodules has been gaining more widespread adoption in the United States, there is limited societal guidance for its role, and safe adoption. As many of the first adopters of thyroid nodule RFA developed their practices, they looked to the Korean Society of Interventional Radiology (KSIR), and European Thyroid Association (ETA) guidelines as a framework. Currently, efforts are underway from the American Thyroid Association to create updated guidelines for US providers. International consensus guidelines are also underway. Until these guidelines are available, a thorough understanding of the current available guidelines is key for interventionalists building a thyroid nodule RFA program.

Thyroid nodules are common and often asymptomatic. However, patients may seek treatment for nonfunctional benign nodules that cause compressive symptoms or cosmetic problems. Additionally, many patients with autonomously functioning nodules also seek treatment. As minimally invasive thermal ablation techniques become more wide spread, providers offering these treatments should be familiar with the pathophysiology of thyroid nodules, and with how to work up a patient with nodular thyroid disease.

In the past decade, there has seen been a shift from treating all thyroid cancer surgically, to favoring less aggressive approaches for low-risk thyroid cancer. Surgery was historically the treatment of choice for most thyroid cancer. Active surveillance has emerged as an alternative for low-risk thyroid cancer in select patients. This approach has been accepted worldwide, and sound evidence supports its oncological safety in carefully selected patients. However, not all patients want to undergo lifelong monitoring, and some patients may wish to treat their cancer in a minimally invasive manner. Thermal ablation has developed as a minimally invasive alternative to surgery and active surveillance for well selected patients with thyroid malignancy. Herein, we review the role of thermally ablative techniques, specifically radiofrequency ablation, for the treatment of small primary thyroid cancers, recurrent thyroid cancer, and lymph node metastases.

A good understanding of the anatomic structures of the neck surrounding the thyroid gland is a requisite for safely performing image guided procedures on the thyroid gland. Patients presenting for treatment of thyroid nodules can have anatomy that is distorted by the nodules or by prior surgery. This pictorial review describes the anatomy of the thyroid gland and surrounding structures. Additionally, a review of how to perform an ultrasound exam of the thyroid gland and how to categorize thyroid nodules is included.

Symptomatic solid benign thyroid nodules may present either as nonfunctioning nodules causing compressive symptoms or as hyperfunctioning nodules causing symptoms of hyperthyroidism. While surgical resection or radioiodine ablation of these nodules can be performed, percutaneous radiofrequency ablation (RFA) of benign solid thyroid nodules has been shown to be a safe and effective alternative in select patients. Preprocedural evaluation should include a history focusing on signs and symptoms of thyroid dysfunction, a physical exam, thyroid ultrasound, thyroid function tests, and discussion of key intraprocedural details with the patient such as the anesthesia plan and risks. Thyroid RFA can be safely performed as an outpatient procedure with less than 2% major and minor complication rates. This report will focus on the basic technique of performing RFA for symptomatic thyroid nodules.

The optimal treatment option for cystic thyroid lesions depends on the composition of the lesion, prior interventions, and patient preference. Simple aspiration is a good initial diagnostic and treatment modality for thyroid lesions that are predominantly cystic. However, recurrence rates are high and, should fluid re-accumulate, further aspirations are unlikely to be effective. Ethanol ablation is an excellent first line treatment as it is relatively safe, well-tolerated, and simple to perform. It is at least as effective, if not more effective, than radiofrequency ablation (RFA) for simple cysts, and complex thyroid cysts with a solid component <20%. The efficacy of EA is inversely related to the percentage of solid component within any given lesion. There is some evidence that complex cysts with >20% solid component may have better long-term outcomes with RFA over EA, although EA is still a reasonable first line consideration. RFA salvage after EA is possible and effective, especially for complex nodules with larger solid components.

Radiofrequency ablation (RFA) is an increasingly popular non-surgical alternative for the treatment of benign thyroid nodules. Although RFA is less invasive than surgery, it is not without its own risks with major complications occurring at a rate ranging up to 3.8% in large systematic reviews. We review the range of minor and major complications that have been described after thyroid RFA and their potential management. We also review recommended post-ablation follow-up schedules as well as expectations on thyroid nodule volume rate reduction after treatment. Long term follow-up is necessary as there can be regrowth of ablated thyroid nodules due to an undertreated nodule margin. Overall, RFA has been shown to be a consistently safe and effective treatment for thyroid nodules with excellent long-term results.