Download PDF
Semin intervent Radiol 2019; 36(01): 049-062
DOI: 10.1055/s-0039-1679952
How I Do It
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Imaging Techniques to Aid IR Treatment of Musculoskeletal Malignancy

A. Kyle Jones
1   Division of Diagnostic Imaging, Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Steven Yevich
2   Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
29 March 2019 (online)

Also available at
    Permissions and Reprints

The minimally invasive image-guided approach to musculoskeletal (MSK) malignancy requires mastery of multiple different imaging modalities. The therapeutic approach can include embolization, thermal ablation, cement consolidation, and percutaneous screw fixation.[1] While some treatments require one specific modality and approach, others might be best performed using multiple modalities or techniques in concert.[2] [3] [4] [5] The challenges to the approach are often due to the wide spectrum of disease presentation related to variable tumor biology, location, size, and vascularity. A firm familiarity with the latest advancements in imaging equipment and software can improve the patient-tailored approach.

Several recent advances in medical imaging can improve minimally invasive treatment options for MSK malignancy. For example, innovation in hardware and software applications has improved the quality of anatomical detail to facilitate visualization of tumor and surrounding critical structures. Needle guidance and fusion capabilities have expanded the treatment potential by expanding the potential combined applications of multiple imaging modalities. The proper application of these technological improvements requires a basic understanding of specific imaging parameters and the underlying medical imaging physics.

This article will review the latest advancements and applications for ultrasound , fluoroscopy, computed tomography (CT), and magnetic resonance imaging (MRI) as applied to the treatment of MSK malignancy. Basic technical information will be reviewed, as will imaging optimization techniques to improve procedural outcomes and safety for both the patient and proceduralist. Lastly, new software technologies and future directions will be presented for each imaging modality that may assist in treatment approach or assessment of immediate procedural effect.

 

  • References

  • 1 Kurup AN, Callstrom MR. Expanding role of percutaneous ablative and consolidative treatments for musculoskeletal tumours. Clin Radiol 2017; 72 (08) 645-656
    CrossrefPubMedGoogle Scholar
  • 2 Wallace AN, Greenwood TJ, Jennings JW. Radiofrequency ablation and vertebral augmentation for palliation of painful spinal metastases. J Neurooncol 2015; 124 (01) 111-118
    CrossrefPubMedGoogle Scholar
  • 3 Nakatsuka A, Yamakado K, Maeda M. , et al. Radiofrequency ablation combined with bone cement injection for the treatment of bone malignancies. J Vasc Interv Radiol 2004; 15 (07) 707-712
    CrossrefPubMedGoogle Scholar
  • 4 Munk PL, Rashid F, Heran MK. , et al. Combined cementoplasty and radiofrequency ablation in the treatment of painful neoplastic lesions of bone. J Vasc Interv Radiol 2009; 20 (07) 903-911
    CrossrefPubMedGoogle Scholar
  • 5 Hartung MP, Tutton SM, Hohenwalter EJ, King DM, Neilson JC. Safety and efficacy of minimally invasive acetabular stabilization for preacetabular metastatic disease with thermal ablation and augmented screw fixation. J Vasc Interv Radiol 2016; 27 (05) 682-688.e1
    CrossrefPubMedGoogle Scholar
  • 6 Claudon M, Dietrich CF, Choi BI. , et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med 2013; 34 (01) 11-29
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Dietrich CF, Averkiou M, Nielsen MB. , et al. How to perform contrast-enhanced ultrasound (CEUS). Ultrasound Int Open 2018; 4 (01) E2-E15
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Cosgrove D. Microbubble enhancement of tumor neovascularity. Eur Radiol Suppl 1999; 3: S413-S414
    PubMedGoogle Scholar
  • 9 Bang N, Bachmann Nielsen M, Vejborg I, Mellon Mogensen A. Clinical report: contrast enhancement of tumor perfusion as a guidance for biopsy. Eur J Ultrasound 2000; 12 (02) 159-161
    CrossrefPubMedGoogle Scholar
  • 10 Pass B, Jafari M, Rowbotham E, Hensor EMA, Gupta H, Robinson P. Do quantitative and qualitative shear wave elastography have a role in evaluating musculoskeletal soft tissue masses?. Eur Radiol 2017; 27 (02) 723-731
    CrossrefPubMedGoogle Scholar
  • 11 Hakime A, Yevich S, Tselikas L, Deschamps F, Petrover D, De Baere T. Percutaneous thermal ablation with ultrasound guidance. Fusion imaging guidance to improve conspicuity of liver metastases. Cardiovasc Intervent Radiol 2017; 40 (05) 721-727
    CrossrefPubMedGoogle Scholar
  • 12 Jones AK, Balter S, Rauch P, Wagner LK. Medical imaging using ionizing radiation: optimization of dose and image quality in fluoroscopy. Med Phys 2014; 41 (01) 014301
    PubMedGoogle Scholar
  • 13 Euler A, Solomon J, Marin D, Nelson RC, Samei E. A third-generation adaptive statistical iterative reconstruction technique: phantom study of image noise, spatial resolution, lesion detectability, and dose reduction potential. AJR Am J Roentgenol 2018; 210 (06) 1301-1308
    CrossrefPubMedGoogle Scholar
  • 14 Chen B, Ramirez Giraldo JC, Solomon J, Samei E. Evaluating iterative reconstruction performance in computed tomography. Med Phys 2014; 41 (12) 121913
    CrossrefPubMedGoogle Scholar
  • 15 Solomon J, Mileto A, Ramirez-Giraldo JC, Samei E. Diagnostic performance of an advanced modeled iterative reconstruction algorithm for low-contrast detectability with a third-generation dual-source multidetector CT scanner: potential for radiation dose reduction in a multireader study. Radiology 2015; 275 (03) 735-745
    CrossrefPubMedGoogle Scholar
  • 16 Tam AL, Ensor JE, Zvavanjanja RC. , et al. Standardizing CT-guided biopsy procedures: patient dose and image noise. AJR Am J Roentgenol 2015; 205 (04) W390-W399
    CrossrefPubMedGoogle Scholar
  • 17 Yu L, Leng S, McCollough CH. Dual-energy CT-based monochromatic imaging. AJR Am J Roentgenol 2012; 199 (5, Suppl): S9-S15
    CrossrefPubMedGoogle Scholar
  • 18 Jones AK, Dixon RG, Collins JD, Walser EM, Nikolic B. ; on behalf of the Society of Interventional Radiology Health and Safety Committee. Best practices guidelines for CT-guided interventional procedures. J Vasc Interv Radiol 2018; 29 (04) 518-519
    CrossrefPubMedGoogle Scholar
  • 19 Siewerdsen JH, Jaffray DA. Cone-beam computed tomography with a flat-panel imager: magnitude and effects of x-ray scatter. Med Phys 2001; 28 (02) 220-231
    CrossrefPubMedGoogle Scholar
  • 20 Steuwe A, Geisbüsch P, Schulz CJ, Böckler D, Kauczor HU, Stiller W. Comparison of radiation exposure associated with intraoperative cone-beam computed tomography and follow-up multidetector computer tomography angiography for evaluating endovascular aneurysm repairs. J Endovasc Ther 2016; 23 (04) 583-592
    CrossrefPubMedGoogle Scholar
  • 21 Bai M, Liu B, Mu H, Liu X, Jiang Y. The comparison of radiation dose between C-arm flat-detector CT (DynaCT) and multi-slice CT (MSCT): a phantom study. Eur J Radiol 2012; 81 (11) 3577-3580
    CrossrefPubMedGoogle Scholar
  • 22 Kwok YM, Irani FG, Tay KH, Yang CC, Padre CG, Tan BS. Effective dose estimates for cone beam computed tomography in interventional radiology. Eur Radiol 2013; 23 (11) 3197-3204
    CrossrefPubMedGoogle Scholar
  • 23 Jones AK. Abstract 1017: An Apples to Apples Comparison of Radiation Dose and Image Quality between Flat Panel CT and Multidetector CT. Society of Interventional Radiology Annual Meeting. Los Angeles, CA; 2018
    PubMedGoogle Scholar
  • 24 Smith KA, Carrino JA. MRI-guided interventions of the musculoskeletal system. J Magn Reson Imaging 2008; 27 (02) 339-346
    CrossrefPubMedGoogle Scholar
  • 25 Sequeiros RB, Ojala R, Kariniemi J. , et al. MR-guided interventional procedures: a review. Acta Radiol 2005; 46 (06) 576-586
    CrossrefPubMedGoogle Scholar
  • 26 Ahrar K, Sabir SH, Yevich SM. , et al. MRI-guided interventions in musculoskeletal system. Top Magn Reson Imaging 2018; 27 (03) 129-139
    CrossrefPubMedGoogle Scholar
  • 27 Napoli A, Anzidei M, Ciolina F. , et al. MR-guided high-intensity focused ultrasound: current status of an emerging technology. Cardiovasc Intervent Radiol 2013; 36 (05) 1190-1203
    CrossrefPubMedGoogle Scholar
  • 28 de Senneville BD, Mougenot C, Quesson B, Dragonu I, Grenier N, Moonen CTW. MR thermometry for monitoring tumor ablation. Eur Radiol 2007; 17 (09) 2401-2410
    CrossrefPubMedGoogle Scholar
  • 29 Zhu M, Sun Z, Ng CK. Image-guided thermal ablation with MR-based thermometry. Quant Imaging Med Surg 2017; 7 (03) 356-368
    CrossrefPubMedGoogle Scholar
  • 30 Wansapura JP, Daniel BL, Vigen KK, Butts K. In vivo MR thermometry of frozen tissue using R2* and signal intensity. Acad Radiol 2005; 12 (09) 1080-1084
    CrossrefPubMedGoogle Scholar
  • 31 Overduin CG, Fütterer JJ, Scheenen TW. 3D MR thermometry of frozen tissue: feasibility and accuracy during cryoablation at 3T. J Magn Reson Imaging 2016; 44 (06) 1572-1579
    CrossrefPubMedGoogle Scholar
  • 32 Kanal E, Barkovich AJ, Bell C. , et al; Expert Panel on MR Safety. ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging 2013; 37 (03) 501-530
    CrossrefPubMedGoogle Scholar
  • 33 National Council on Radiation Protection and Measurements. Radiation Dose Management for Fluoroscopically-Guided Interventional Medical Procedures. NCRP Report 168. Bethesda, MD: NCRP; 2011
    Google Scholar
  • 34 IEC. International Electrotechnical Commission. Medical Electrical Equipment–Part 2–43: Particular Requirements for the Basic Safety and Essential Performance of X-Ray Equipment for Interventional Procedures, IEC 60601–2-43 ed 2.0. Geneva: International Electrotechnical Commission; 2010
    Google Scholar