Techniques in Vascular and Interventional Radiology最新文献

英文中文

Image Guided Percutaneous Robotic Interventions for Solid Organs 图像引导的经皮实体器官机器人介入治疗。

IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2024-12-01 DOI: 10.1016/j.tvir.2024.101006

Govindarajan Narayanan MD , Ripal T. Gandhi MD , Bente A.T. van den Bemd MD

Robotic systems for minimally invasive procedures, particularly in interventional oncology, have advanced significantly, especially for percutaneous interventions guided by CT, Cone-beam CT, and MRI. These systems, which include needle-guiding and needle-driving robots, enhance the precision of procedures like biopsy and tumor ablation. Needle-guiding robots plan and align the needle, while needle-driving robots autonomously advance it, improving needle placement accuracy, enabling out-of-plane insertion, and reducing radiation exposure. These robotic systems offer key clinical benefits, such as stable needle guidance for challenging angulated approaches and better access to lesions in confined spaces, like CT or MRI gantries. They can guide the needle to the optimal region of a lesion without the need for a second contrast injection, improving both diagnosis and treatment. While many robotic systems have been developed, only a few have reached clinical use. Early studies show promising results, but concerns about increased complexity and cost remain. Further research and clinical trials are needed to fully evaluate their value, though we believe that robotic systems will play an increasingly important role in the future of image-guided interventions, particularly for challenging tumors.

用于微创手术的机器人系统，特别是在介入肿瘤学领域，特别是在CT、锥束CT和MRI引导下的经皮介入手术方面取得了显著进展。这些系统包括针导向和针驱动机器人，提高了活检和肿瘤消融等手术的精度。针导向机器人规划和对准针，而针驱动机器人自动推进针，提高针的放置精度，实现面外插入，并减少辐射暴露。这些机器人系统提供了关键的临床益处，例如稳定的针头引导，以应对具有挑战性的成角入路，以及更好地进入狭窄空间的病变，如CT或MRI龙门。它们可以将针引导到病变的最佳区域，而不需要第二次注射造影剂，从而改善诊断和治疗。虽然已经开发了许多机器人系统，但只有少数达到了临床应用。早期的研究显示出有希望的结果，但对复杂性和成本增加的担忧仍然存在。需要进一步的研究和临床试验来充分评估它们的价值，尽管我们相信机器人系统将在未来的图像引导干预中发挥越来越重要的作用，特别是对于具有挑战性的肿瘤。

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引用次数: 0

Health inequities, bias, and artificial intelligence 健康不平等、偏见和人工智能

IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.tvir.2024.100990

Hanzhou Li , John T. Moon , Vishal Shankar , Janice Newsome , Judy Gichoya , Zachary Bercu

Musculoskeletal (MSK) pain leads to significant healthcare utilization, decreased productivity, and disability globally. Due to its complex etiology, MSK pain is often chronic and challenging to manage effectively. Disparities in pain management—influenced by provider implicit biases and patient race, gender, age, and socioeconomic status—contribute to inconsistent outcomes. Interventional radiology (IR) provides innovative solutions for MSK pain through minimally invasive procedures, which can alleviate symptoms and reduce reliance on opioids. However, IR services may be underutilized, especially due to current treatment paradigms, referral patterns, and in areas with limited access to care. Artificial intelligence (AI) presents a promising avenue to address these inequities by analyzing large datasets to identify disparities in pain management, recognizing implicit biases, improving cultural competence, and enhancing pain assessment through multimodal data analysis. Additionally, patients who may benefit from an IR pain procedure for their MSK pain may then receive more information through their providers after being identified as a candidate by AI sifting through the electronic medical record. By leveraging AI, healthcare providers can potentially mitigate their biases while ensuring more equitable pain management and better overall outcomes for patients.

在全球范围内，肌肉骨骼（MSK）疼痛导致大量医疗保健使用、生产力下降和残疾。由于病因复杂，MSK 疼痛通常是慢性的，难以有效控制。受医疗服务提供者的隐性偏见以及患者的种族、性别、年龄和社会经济地位的影响，疼痛治疗中存在的差异导致了治疗结果的不一致。介入放射学（IR）通过微创手术为 MSK 疼痛提供了创新的解决方案，可减轻症状并减少对阿片类药物的依赖。然而，介入放射学服务可能未得到充分利用，特别是由于目前的治疗模式、转诊模式以及在医疗服务有限的地区。人工智能（AI）通过分析大型数据集来识别疼痛管理中的差异、识别隐性偏见、提高文化能力，并通过多模态数据分析来加强疼痛评估，为解决这些不公平现象提供了一条前景广阔的途径。此外，在人工智能通过电子病历筛选出候选者后，可能从 IR 疼痛程序中获益的 MSK 疼痛患者可以通过医疗服务提供者获得更多信息。通过利用人工智能，医疗服务提供者有可能减少他们的偏见，同时确保为患者提供更公平的疼痛管理和更好的整体治疗效果。

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引用次数: 0

Visceral nerve interventions in interventional radiology 介入放射学中的内脏神经介入术

IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.tvir.2024.100983

Shen Ning, Samir Ghandour, Ashraf Thabet, Shams Iqbal

Chronic abdominal visceral pain management often requires multidisciplinary collaboration. Image-guided visceral nerve interventions may be critical in the management of visceral pain refractory to medical treatments. Abdominal and pelvic pain is mediated by specific nerves involving specific ganglia. The well-defined location of these ganglia provides important targets for percutaneous image-guided interventions to alleviate chronic abdominal or pelvic pain. In this review, we provide an in-depth discussion of the anatomy, indications, evidence, and technical and clinical considerations and complications for celiac plexus, superior hypogastric, inferior hypogastric, and ganglion impar block and neurolysis.

慢性腹部内脏疼痛的治疗通常需要多学科协作。图像引导下的内脏神经干预可能是治疗药物治疗难治性内脏疼痛的关键。腹部和盆腔疼痛由涉及特定神经节的特定神经介导。这些神经节的明确位置为缓解慢性腹痛或盆腔痛的经皮图像引导介入治疗提供了重要目标。在这篇综述中，我们将深入讨论腹腔神经丛、胃下上神经、胃下神经和神经节阻滞和神经溶解的解剖、适应症、证据、技术和临床注意事项及并发症。

引用次数: 0

Keeping it "straight": how to do spinal tumor ablation with vertebral augmentation 保持 "直线"：如何通过椎体增强进行脊柱肿瘤消融术

IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.tvir.2024.100988

Koustav Pal MBBS, Rahul A. Sheth MD FSIR, Milan N. Patel MD

This technical review provides a comprehensive overview of spinal tumor ablation and vertebral augmentation. These percutaneous minimally invasive procedures offer significant survival and palliative pain relief benefits for patients with pathological vertebral fractures. Vertebral augmentation, which includes vertebroplasty and kyphoplasty, involves injecting cement into fractured vertebral bodies to restore height. While vertebroplasty involves the direct injection of cement into a fractured vertebral body, kyphoplasty involves using a balloon to create a low-pressure cavity to allow for cement injection to restore the vertebral body height. Over the years, this technique has evolved into a straightforward process, though it presents certain technical challenges discussed in this article.

本技术综述全面概述了脊柱肿瘤消融术和椎体增生术。这些经皮微创手术对病理性椎体骨折患者的生存和缓解疼痛有显著疗效。椎体增高术包括椎体成形术和椎体后凸成形术，涉及向骨折椎体注入骨水泥以恢复椎体高度。椎体成形术是将骨水泥直接注入骨折的椎体，而椎体成形术则是用气球制造一个低压腔，以便注入骨水泥恢复椎体高度。多年来，这种技术已发展成为一种简单易行的过程，但它也面临着本文讨论的某些技术挑战。

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Epidural steroid injection technique 硬膜外类固醇注射技术

IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.tvir.2024.100981

Ben McCafferty MD , Roger Williams DO

An epidural steroid injection (ESI) is a minimally invasive, image guided procedure for the treatment of back pain. Pain originating in the lumbar spine is the most common referral for ESI but the entire spine may be targeted. ESI can provide temporary but meaningful relief for patients who may have failed conservative management with oral analgesics and physical therapy. ESI may provide analgesia and anti-inflammatory effects that allow more conservative measures like physical therapy to become more effective. ESI also serves as a bridge between conservative and surgical management, intervention for postsurgical pain, or an alternative for nonsurgical candidates. This article reviews the technique for performing ESI in the cervical, thoracic, and lumbosacral spine.

硬膜外类固醇注射（ESI）是一种微创、图像引导的治疗背部疼痛的方法。腰椎疼痛是 ESI 最常见的转诊病因，但也可针对整个脊柱进行治疗。对于口服止痛药和物理疗法等保守疗法无效的患者，ESI 可以提供暂时但有意义的缓解。ESI 可提供镇痛和消炎效果，使物理治疗等保守治疗变得更加有效。ESI 还可作为保守治疗和手术治疗之间的桥梁，对手术后疼痛进行干预，或作为非手术候选者的替代治疗方法。本文回顾了在颈椎、胸椎和腰骶部实施 ESI 的技术。

引用次数: 0

Vertebral augmentation: How we do it 椎体增强术：我们是如何做到的

IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.tvir.2024.100979

Junaid Raja MD MSPH , Jake DiFatta BS , Junjian Huang MD , Dana Dunleavy MD

Vertebral augmentation consists of minimally invasive techniques indicated in the treatment of vertebral compression fractures (VCFs). These compression fractures cause vertebral body height loss and consequent significant pain and are most frequently the result of osteoporosis, cancer metastasis, or trauma. The deleterious effects of VCFs often compound, as greater load-bearing stress is transferred to the remaining healthy vertebrae. Kyphoplasty, vertebroplasty, and intravertebral implants are closely related vertebral augmentation techniques that serve to relieve pain and to counter pathophysiological stress and structural degradation of the vertebral column alignment. All 3 approaches are performed percutaneously and are therefore attractive options for patients deemed to be poor candidates for open surgery.

Each technique involves transpedicular needle access to the vertebral body matrix, followed by introduction of a cement-like polymer through a catheter to fill the space and provide structural fortification. Vertebroplasty involves injection of the cement material into the matrix space without any adjunctive measures. In kyphoplasty, a balloon is first introduced to expand the collapsed, fractured area with the goal of approximating the prefracture anatomy of the vertebral body and thereby spinal curvature, promptly followed by cement introduction. In intravertebral implantation procedures, a permanent jack is inserted into the vertebral body matrix and expanded craniocaudally, with the same purpose of restoring normal structure, before the matrix space is filled with cement polymer. This article provides an overview of these vertebral augmentation techniques, including pre and postprocedural considerations, with an emphasis on the technical aspects of the interventions.

椎体增量术包括用于治疗椎体压缩性骨折（VCF）的微创技术。椎体压缩性骨折会导致椎体高度降低，从而引起剧烈疼痛，最常见的原因是骨质疏松症、癌症转移或外伤。由于更大的承重压力会转移到剩余的健康椎体上，因此 VCF 的有害影响往往会加重。椎体成形术（Kyphoplasty）、椎体成形术（Verbroplasty）和椎体内植入物（Intraverbral implants）是密切相关的椎体增强技术，可缓解疼痛，对抗病理生理压力和椎体排列结构退化。这三种方法都是经皮进行的，因此对于不适合进行开放手术的患者来说是很有吸引力的选择。每种技术都涉及经皮穿刺针进入椎体基质，然后通过导管导入类似水泥的聚合物，以填充空间并提供结构加固。椎体成形术是将骨水泥材料注入基质间隙，不采取任何辅助措施。在椎体后凸成形术中，首先引入一个球囊以扩大塌陷的骨折区域，目的是接近椎体骨折前的解剖结构，从而使脊柱弯曲，随后迅速引入骨水泥。在椎体内植入手术中，先将永久性千斤顶插入椎体基质并向颅内扩张，目的同样是恢复正常结构，然后再用骨水泥聚合物填充基质空间。本文概述了这些椎体增量技术，包括术前和术后的注意事项，重点介绍了介入的技术方面。

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引用次数: 0

Targeted drug delivery via intrathecal pain pump for the treatment of malignant pain 通过鞘内止痛泵靶向给药治疗恶性疼痛

IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.tvir.2024.100985

Dr. George Zlotchenko MD , Dr. Thor Johnson MD, PhD , Katherine Kelson BA

Cancer patients experience pain at significant rates but are often undertreated—it is estimated that less than 1% of eligible cancer pain patients receive appropriate targeted drug delivery to address their pain. Cancer pain is often managed with systemic opioid treatment; however, this approach is limited in treating pain adequately and carries significant side effect risk profiles. Successful treatment of pain is closely tied to better oncologic outcomes as well as better measures on assessments of quality of life for cancer patients. Placement of intrathecal pain pumps represent a safe and effective way to manage pain in cancer patients. We describe the process of placing intrathecal pain pumps in an interventional radiology suite. This method of pump placement represents a minimally invasive approach to long term and continuous pain relief. Intrathecal pain pumps help maximize pain control for patients experiencing refractory pain due to disease process or treatments associated with malignancy.

据估计，在符合条件的癌症疼痛患者中，只有不到 1%的患者接受了适当的靶向药物治疗。癌症疼痛通常采用全身性阿片类药物治疗；然而，这种方法在充分治疗疼痛方面存在局限性，而且副作用风险很大。成功的疼痛治疗与更好的肿瘤治疗效果以及更好的癌症患者生活质量评估密切相关。放置鞘内镇痛泵是控制癌症患者疼痛的一种安全有效的方法。我们描述了在介入放射科手术室放置鞘内镇痛泵的过程。这种泵植入方法是一种长期、持续缓解疼痛的微创方法。鞘内镇痛泵有助于最大限度地控制因疾病过程或恶性肿瘤相关治疗而引起的难治性疼痛患者的疼痛。

引用次数: 0

Thoracolumbar spinal cord stimulation: technique and overview 胸腰椎脊髓刺激术：技术与概述

IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.tvir.2024.100986

Christopher Paul MD, Rene Powell DO, Prentiss Lawson MD

Since the introduction of spinal cord stimulation in 1967, the therapy has become a cornerstone in the treatment of several chronic pain syndromes, including but not limited to: postlaminectomy syndrome, lumbar radiculopathy, complex regional pain syndrome and diabetic peripheral neuropathy. This article aims to examine the methodology and practical considerations involved in thoracolumbar spinal cord stimulation implementation, emphasizing procedural techniques and critical criteria for selecting patients to achieve optimal outcomes and minimization of complications.

自 1967 年引入脊髓刺激疗法以来，该疗法已成为治疗多种慢性疼痛综合征的基石，包括但不限于：椎板切除术后综合征、腰椎病、复杂区域疼痛综合征和糖尿病周围神经病变。本文旨在探讨胸腰椎脊髓刺激术的实施方法和实际注意事项，强调程序技术和选择患者的关键标准，以达到最佳疗效并将并发症降至最低。

引用次数: 0

Basivertebral nerve ablation technique 椎基底神经消融技术

IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.tvir.2024.100987

John B. Smirniotopoulos MS, MD , Uchenna Osuala MS , Clark R. Restrepo MD , Junjian Huang MD

Chronic low back pain represents a leading cause of global disability, but can often be complex in etiology, with multiple pain generators contributing to patient discomfort. Anterior column low back pain involves the vertebral bodies and discs, with the vertebral body endplates now known to be a significant pain generator. Vertebrogenic low back pain secondary to irritation of the basivertebral nerve presents as axial discomfort, worse with forward flexion, and with concomitant Type I or II Modic changes on MRI. Minimally invasive basivertebral nerve radiofrequency ablation has emerged as an effective intervention for managing anterior column back pain. In this article, the authors present a comprehensive approach to identifying and treating vertebrogenic low back pain through image guided basivertebral nerve ablation. We outline the patient presentation and diagnostic workup, followed by a detailed procedural guide including equipment requirements, technique execution, and potential technical challenges and complications.

慢性腰背痛是导致全球残疾的一个主要原因，但其病因往往很复杂，有多种致痛因素导致患者不适。前柱性腰痛涉及椎体和椎间盘，目前已知椎体终板是重要的疼痛源。继发于椎基底神经刺激的椎源性腰痛表现为轴向不适，前屈时加重，核磁共振成像上伴有 I 型或 II 型 Modic 改变。微创椎基底神经射频消融术已成为治疗前柱腰痛的有效干预方法。在本文中，作者介绍了一种通过图像引导椎基底神经消融术识别和治疗椎源性腰痛的综合方法。我们概述了患者的表现和诊断工作，随后提供了详细的程序指南，包括设备要求、技术执行以及潜在的技术挑战和并发症。

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Percutaneous spinal decompression 经皮脊柱减压

IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Techniques in Vascular and Interventional Radiology

Pub Date : 2024-09-01 DOI: 10.1016/j.tvir.2024.100980

Kelly Trinh , Mohammad Ghasemi-Rad , Dimitrios Filiapadis , Zubin Irani

Symptoms arise when narrowing of the spinal canal, lateral recesses, or intervertebral foramina impinge upon the neural structures that traverse the spinal column. Pathology involving the structures that make up the spine can narrow the relevant spaces. Here a description of percutaneous procedures that address narrowing from disc disease, ligamentum Flavum hypertrophy, and devices that open and stabilize the spine at individual levels are presented.

当椎管、侧凹或椎间孔的狭窄影响到穿越脊柱的神经结构时，就会出现症状。脊柱结构的病变会使相关空间变窄。这里介绍的经皮手术可解决因椎间盘疾病、韧带肥大造成的狭窄问题，以及在各个层面打开和稳定脊柱的装置。

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全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

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Techniques in Vascular and Interventional Radiology

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