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Semin intervent Radiol 2019; 36(01): 049-062
DOI: 10.1055/s-0039-1679952
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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
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Publication Date:
29 March 2019 (online)

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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.