CT-guided Percutaneous Injection Research Articles

CT-Guided Percutaneous Thrombin Injection of Posttraumatic Aortic Branch Pseudoaneurysm

AbstractA pseudoaneurysm of an aortic branch artery is a potentially life-threatening uncommon occurrence, which may result in retroperitoneal hemorrhage. Imaging-guided percutaneous thrombin injection has a high technical success and effectiveness rate for treating pseudoaneurysms of the femoral, iliac, and popliteal arteries. We present a case of a retroperitoneal hemorrhage in a patient with a periaortic branch pseudoaneurysm, potentially from an avulsed lumbar artery. Anatomy prevented fixation with a covered stent; the comorbidities eliminated safe surgical repair, and endovascular embolization was not an option due to the avulsion. Computed tomography (CT) fluoroscopy-guided thrombin injection provided a safe, successful embolization with no postprocedural complications.

Preoperative computer tomography-guided indocyanine green injection is associated with successful localization of small pulmonary nodules.

BackgroundLocalization of small pulmonary nodules (SPNs) is challenging in minimally invasive pulmonary resection, and it is unknown whether computer tomography (CT) guided by indocyanine green (ICG) can provide accurate localization with minimal complications.MethodsWe performed a retrospective study of patients who underwent thoracoscopic resection of pulmonary nodules after CT-guided preoperative localization with ICG from May 2019 to May 2020. Demographics, procedural data, postoperative complications, and pathologic information, were collected, and an analysis of the accuracy and complications after surgery was conducted.ResultsIn 471 patients, there was a total of 512 peripheral pulmonary nodules that were ≤2 cm in size. The average time for CT-guided percutaneous ICG injection for localization was 18 minutes, and 98.4% (504/512) of the nodules were successfully localized. The average size of the nodules was 9.1 mm, and the average depth from the pleural surface was 8.9 mm. Overall, 5.9% (28/471) of the patients had asymptomatic pneumothorax after localization, but none needed a tube thoracostomy. All the nodules were resected using video-assisted thoracoscopy technique.ConclusionsPreoperative CT-guided transthoracic ICG injection is safe and feasible for localization of small lung nodules for minimally invasive pulmonary resection. This technique should be considered for preoperative CT-guided localization of small lung nodules.

S1598 Insulinoma: A Recurrent Pancreatic Mass Amendable to CT-Guided Ethanol-Lipiodol Injection

INTRODUCTION: Insulinomas are a rare, neuroendocrine tumor of the pancreas. We present a unique case of a recurrent insulinoma successfully treated with CT-guided percutaneous ethanol-lipiodol injection. CASE DESCRIPTION/METHODS: An 81 year old female presented to our center with persistent episodes of hypoglycemia during which she reports palpitations, diaphoresis, and confusion. The patient’s past medical history is significant for recurrent hypoglycemia initially due to a 2.5 cm insulinoma at the pancreatic head diagnosed 15 years prior amendable to enucleation therapy. Symptom recurrence 7 years later was significant for a 2 cm neuroendocrine tumor located at the previous surgical bed treated with a pyloric-preserving pancreatoduodenectomy (Whipple procedure). She was symptom free for 7 years prior to reoccurrence for a third time. EUS with fine needle aspiration (FNA) at that time was non-diagnostic and negative for neoplastic immunohistochemistry. On presentation, in our gastrointestinal (GI) clinic patient was hypoglycemic although vitals and physical exam were unremarkable. With concern of reoccurrence of insulinoma, magnetic resonance (MR) abdomen found a 3.8 cm heterogeneous mass posterior and caudal to the pancreatic anastomosis from prior Whipple procedure (Figure 1A). It was decided to proceed with repeat EUS with FNA. EUS was significant for a 3.8 cm, retroperitoneal mass. FNA Biopsy was significant for reoccurrence of insulinoma. The retroperitoneal location and size of the recurrent insulinoma posed a clinically difficult situation to address and focus was placed on symptom management as opposed to tumor removal. EUS with radiofrequency ablation (RFA) was not considered due to the size of the mass, and surgical debulking was ruled out due to the tumor’s retroperitoneal location and patient’s altered post-surgical anatomy. It was decided to proceed with CT-guided percutaneous ethanol-lipiodol injection (Figure 1B). The procedure was successful and the patient was discharged without complications. At follow up 3 months later, the patient reported complete resolution of previous symptoms and repeat MR abdomen showed radiographic evidence of tumor necrosis (Figure 1C). DISCUSSION: Repeat EUS led to expedited diagnosis of a recurrent pancreatic insulinoma and reduced time to treatment. In addition, our case uniquely conveys a successful, alternative approach to addressing symptomatic insulinomas refractory to surgical or medical management, via CT-guided percutaneous ethanol-lipiodol injection.Figure 1.: (A) Contrast-enhanced MRI shows an enlarged, uniformly enhancing porto-caval lymph node metastasis (arrowheads) from pancreatic neuroendocrine tumor. (B) CT scan image after percutaneous injection of lipiodol/ethanol mixture shows extensive distribution of the high radiodensity material within the metastatic lymph node (arrowheads). (C) Contrast-enhanced MRI 3 months after treatment shows extensive zones of lack of enhancement within the treated metastatic lymph node (arrowheads), indicating tumor necrosis.

Effectiveness and safety of CT-guided percutaneous intrapulmonary injection of indocyanine green for localization of pulmonary nodules and ground glass opacity

Objective: To investigate the effectiveness and safety of CT-guided intrapulmonary injection of indocyanine green (ICG) for preoperative localization of small pulmonary nodules and ground glass opacities. Methods: From October 2018 to July 2019, a total of 34 consecutive patients (39 nodules) who were suspected to be lung cancer and underwent thoracoscopic surgery were enrolled. The size of the nodules was 0.3-2.0 (0.9±0.3) cm, including 6 solid nodules, 9 impure ground glass nodules and 24 pure ground glass nodules. Before operation, ICG was injected into the lung under the guidance of CT for localization. The patient's nodules location, operation and pathology were recorded. The main outcome measures were localization success rate and complication rate. Results: Seven patients (20.6%) had mild complications including six pneumothorax and one intrapulmonary hemorrhage,but all these patients need no special treatment. There was no ICG related side effection all patients. ICG fluorescence can be observed in all localized nodules during surgery. In two patients, the fluorescence was diffused in the thoracic cavity, but the lesion can still be found at the brightest spot of fluorescence. Thirty-eight (97.4%) lesions were successfully found under fluorescence guidance, only one nodule was not found because of its small size (0.3 cm). The shortest fluorescence retention time was more than 5 hours. Conclusion: CT-guided intrapulmonary injection of ICG for localization of pulmonary nodules and ground glass opacities is safe and effective.

Image-guided percutaneous intralesional administration of mesenchymal stromal cells in subjects with chronic complete spinal cord injury: a pilot study

Background aimsThe potential of cell therapies to improve neurological function in subjects with spinal cord injury (SCI) is currently under investigation. In this context, the choice of cell type, dose, route and administration regimen are key factors. Mesenchymal stromal cells (MSCs) can be easily obtained, expanded and are suitable for autologous transplantation. Here we conducted a pilot study that evaluated safety, feasibility and potential efficacy of intralesional MSCs transplantation performed through image-guided percutaneous injection, in subjects with chronic complete SCI. MethodsFive subjects with chronic traumatic SCI (>6 months), at thoracic level, classified as American Spinal Cord Injury Association impairment scale (AIS) grade A, complete injury, were included. Somatosensory evoked potentials (SSEP), spinal magnetic resonance imaging (MRI) and urodynamics were assessed before and after treatment. Autologous MSCs were injected directly into the lesion site through percutaneous injection guided by computerized tomography (CT). ResultsTomography-guided percutaneous cell transplantation was a safe procedure without adverse effects. All subjects displayed improvements in spinal cord independence measure (SCIM) scores and functional independence measure (FIM), mainly due to improvements in bowel movements and regularity. Three subjects showed improved sensitivity to tactile stimulation. Two subjects improved AIS grade to B, incomplete injury, although this was sustained in only one of them during the study follow-up. ConclusionAutologous bone marrow MSC transplantation, performed through CT-guided percutaneous injection, was shown to be safe and feasible. Further studies are required to demonstrate efficacy of this therapeutic scheme.

Treatment of 213 Patients with Symptomatic Tarlov Cysts by CT-Guided Percutaneous Injection of Fibrin Sealant.

There has been a steady progression of case reports and a small surgical series that report successful surgical treatment of Tarlov cysts with concomitant relief of patients' symptoms and improvement in their neurological dysfunction, yet patients are still told that these lesions are asymptomatic by physicians. The purpose of this study was to analyze the efficacy and safety of intervention in 213 consecutive patients with symptomatic Tarlov cysts treated by CT-guided 2-needle cyst aspiration and fibrin sealing. This study was designed to assess outcomes in patients who underwent CT-guided aspiration and injection of ≥1 sacral Tarlov cyst at Johns Hopkins Hospital between 2003 and 2013. In all, 289 cysts were treated in 213 consecutive patients. All these patients were followed for at least 6 months, 90% were followed for 1 year, and 83% were followed for 3-6 years. The aspiration-injection procedure used 2 needles and was performed with the patients under local anesthesia and intravenous anesthesia. In the fibrin-injection stage of the procedure, a commercially available fibrin sealant was injected into the cyst through the deep needle (Tisseel VH). One year postprocedure, excellent results were obtained in 104 patients (54.2% of patients followed), and good or satisfactory results were obtained in 53 patients (27.6%). Thus, 157 patients (81.8%) in all were initially satisfied with the outcome of treatment. At 3-6 years postprocedure, 74.0% of patients followed were satisfied with treatment. There were no clinically significant complications. The aspiration-injection technique described herein constitutes a safe and efficacious treatment option that holds promise for relieving cyst-related symptoms in many patients with very little risk.

A single CT-guided percutaneous intraosseous injection of thermosensitive simvastatin/poloxamer 407 hydrogel enhances vertebral bone formation in ovariectomized minipigs.

The ultimate goal of osteoporosis treatment is prevention of fragile fracture. Local treatment targeting specific bone may decrease the incidence of osteoporotic fractures. We developed an injectable, thermosensitive simvastatin/poloxamer 407 hydrogel; a single CT-guided percutaneous intraosseous injection augmented vertebrae in ovariectomized minipigs. The greatest hazard associated with osteoporosis is local fragility fractures. An adjunct, local treatment might be helpful to decrease the incidence of osteoporotic fracture. Studies have found that simvastatin stimulates bone formation, but the skeletal bioavailability of orally administered is low. Directly delivering simvastatin to the specific bone that is prone to fractures may reinforce the target bone and reduce the incidence of fragility fractures. We developed an injectable, thermosensitive simvastatin/poloxamer 407 hydrogel, conducted scanning electron microscopy, rheological, and drug release analyses to evaluate the delivery system; injected it into the lumbar vertebrae of ovariectomized minipigs via minimally invasive CT-guided percutaneous vertebral injection. Three months later, BMD, microstructures, mineral apposition rates, and strength were determined by DXA, micro-CT, histology, and biomechanical test; expression of VEGF, BMP2, and osteocalcin were analyzed by immunohistochemistry and Western blots. Poloxamer 407 is an effective controlled delivery system for intraosseous-injected simvastatin. A single injection of the simvastatin/poloxamer 407 hydrogel significantly increased BMD, bone microstructure, and strength; the bone volume fraction and trabecular thickness increased nearly 150%, bone strength almost doubled compared with controls (all P < 0.01); and induced higher expression of VEGF, BMP2, and osteocalcin. CT-guided percutaneous vertebral injection of a single simvastatin/poloxamer 407 thermosensitive hydrogel promotes bone formation in ovariectomized minipigs. The underlying mechanism appears to involve the higher expression of VEGF and BMP-2.

CT-guided percutaneous injection of the fibrin glue by 'double needle' technique for the treatment of sacral cysts

Objective To analyze the efficacy and safety of CT-guided percutaneous injection of the fibrin glue by“double needle”technique to treat sacral cyst. Methods Clinical data of 20 cases with“double-needle”injection of fibrin glue technology to treat sacral cyst were retrospectively analyzed.All patients had varying degrees of sacral nerve root compression symptoms.The treatment for sacral cyst was carried out after clear diagnosis was made.On the basis of CT-guided percutaneous injection of fibrin glue,the improved CT-guided percutaneous injection of fibrin glue by“doubleneedle”technique was used to treat these patients.The average dose of fibrin glue was (5.9±2.4) ml.The clinical results of improvement as to pain and neurological function were evaluated after follow-up of an average of 17 months.The assessment criteria were as follows: excellent,complete resolution of signs and symptoms,with the patient returning to his or her regular employment and no recurrence of cysts during 1 year of follow-up,good,symptoms and signs in the legs and perineal region resolved but with persistent pain in the lumbosacral region,which did not interfere with the patient's regular work (the cysts did not recur for 6 months during follow-up),fair,no improvement in clinical symptoms,but a decrease in cyst size on the imaging study,poor,no improvement in clinical symptoms and no observed changes in cyst size in imaging studies or recurrence. Results Most patients experienced some degree of pain relief and functional improvement after fibrin glue therapy,with most experiencing complete or marked resolution of clinical symptoms.Nine patients reported excellent recovery,8 reported good recovery,2 reported fair recovery,and 1 reported poor recovery.The overall percentage of positive outcomes (excellent and good recovery) was 85%.No serious postoperative complications were discovered. Conclusions CT guided percutaneous injection of the fibrin glue by“double needle”technique to treat sacral cyst is an ideal method.“Double needle”technique is simple,safe and reliable. Key words: Sacral cyst; Punctures; Fibrin tissue adhesive; Radiology,interventional;

CT-Guided Percutaneous Chemoablation using an Ethanol-Ethiodol-Doxorubicin Emulsion for the Treatment of Metastatic Lymph Node Carcinoma: A Comparative Study

Current therapies for metastatic lymph node (LN) are a major burden on health-care systems. Alternative such as percutaneous chemoablation using interstitial injection of ethanol or ethanol-ethiodol-drug(s) mixture (EEM) has been successfully applied to solid tumor ablation of the liver, adrenal glands, lymph nodes and others. However, EEM chemoablation efficacy on two most frequent clinical lymph node presentation, isolated or confluent, has not yet been determined. This study was designed to compare the therapeutic effects of CT-guided percutaneous EEM injection (PEEMI) on patients presenting with single or multiple confluent metastatic LN localizations from various carcinoma. Thirty six patients with metastatic LN carcinoma at various anatomical regions were enrolled from 2009 to 2010 over a nine month period. They were separated into two groups: group A includes 24 single isolated metastatic lymph nodes and group B includes 12 multiple and confluent nodes. The primary end point was the ablative efficacy of PEEMI. The intratumoral (IT) EEM distribution and the occurrence of reflux were recorded. Adjuvant systemic chemotherapy was administered after the procedure. Contrast-enhanced CT scans were performed during procedure and follow-up. Six patients were tested for Fluorodeoxyglucose (FDG) fixation before and after the procedure. For group A the EEM IT distribution-to-tumor ratio was 100% vs. 50% to 80% for group B (t = 11.5, p < 0.05). The reflux frequency was 80% for group A versus 30% for group B. For group A, a complete response (CR) rates of 45.8%, 70.8%, 91.7% and a partial response (PR) rates of 54.2%, 29.2%, 8.3% were obtained at 3, 6 and 12 months after therapy. Regarding group B, a CR rate of 0%, 0%, 0% and PR rate of 16.7%, 50%, 58.3% were observed at similar period of time. Standardized rate by direct method was performed and the CR rate (74.5%) for group A was higher than for group B. The tumor FDG uptake was lower 6 months after PEEMII compared with the preoperative images. Five patients presenting with concomitant lung metastasis, had a good local response-node size reduction on postoperative CT scanning, but no response on lung nodules that were progressing. No serious adverse events were observed. A few patients had mild pain during the procedure, which resolved with peritumor injection of local anesthetic. No needle tract seeding or infection occurred. CT-guided PEEMI treatment is a simple, fast and predictable procedure that has better effectiveness on single, well circumscribed metastatic lymph node than on multiple and confluent ones. Technical improvements are expected to bring better results on large nodes that should be confirmed on larger group of patients.

CT-guided percutaneous puncturing and injection of sclerosing agent for the treatment of lung bullae: its clinical application

CT-guided percutaneous puncturing and injection of sclerosing agent for the treatment of lung bullae: its clinical application

Recurrence of primary aldosteronism after percutaneous ethanol injection

Adrenalectomy is the definite treatment for aldosterone-producing adenoma (APA). Percutaneous ethanol or acetic acid injection with computed tomography (CT) guidance has been described as a safe, noninvasive, and effective alternative treatment modality in patients with high surgical risk. We report on a man who was 49 years of age and presented with treatment-resistant hypertension and was later diagnosed with APA. CT-guided percutaneous ethanol injection (PEI) was performed for this high surgical risk patient. He had aldosteronism recurrence 4 years after the ethanol injection, so a second PEI was performed. The tumor size was reduced and his blood pressure was normalized. Therefore, we suggest that clinicians should closely check aldosterone to renin ration and potassium level if percutaneous chemical ablation is considered in functioning adrenal adenomas.

CT-Guided Percutaneous Injection of Fibrin Glue for the Therapy of Symptomatic Arachnoid Cysts

Although often asymptomatic, enlarging sacral arachnoid cysts can also cause significant discomfort. These symptomatic sacral arachnoid cysts require specific treatments to facilitate local decompression. The main drawback of the surgical managements is the high risk of recurrence and complications. To decrease risks, we had been attempting to seek a simple and safe method to manage the symptomatic sacral arachnoid cysts. CT-guided percutaneous fibrin glue therapy is a new nonsurgical alternative. To evaluate the efficacy of the novel nonsurgical approach, we conducted this retrospective study of 38 patients. Thirty-eight patients with symptomatic sacral arachnoid cysts underwent fibrin glue therapy in our hospital between June 2006 and May 2009. The clinical results of improvement in pain and neurologic function were evaluated after an average of 25 months of follow-up, and changes on the imaging findings were evaluated. Preoperative and postoperative pain severity was assessed according to a 10-cm VAS. Moreover, we also analyzed the postoperative complications. Most patients experienced some degree of pain relief and functional improvement after fibrin glue therapy, with most experiencing complete or marked resolution of clinical symptoms. Twenty-one patients (55.3%) reported excellent recovery, 12 (31.5%) reported good recovery, 4 (10.5%) reported fair recovery, and 1 (2.6%) reported poor recovery. The overall percentage of positive outcomes (excellent and good recovery) was 86.8%. No serious postoperative complications were discovered. CT-guided percutaneous injection of fibrin glue therapy is simple, safe, and effective for the management of symptomatic sacral arachnoid cysts.

CT-guided single high-dose percutaneous acetic acid injection for small hepatocellular carcinoma: A long-term follow-up study

To evaluate the long-term outcome of CT-guided single high-dose percutaneous acetic acid injection (PAI) for the treatment of small hepatocellular carcinoma (SHCC). Sixty-eight consecutive patients (37 men and 31 women; age 52 ± 16 years) with SHCC have undergone CT-guided single high-dose PAI therapy since December 2000. Complications of high-dose PAI were recorded. Tumour survival and recurrence rates were assessed. All PAI therapies were successful and no severe complications developed. The average follow-up period was 46 ± 18 months. The overall survival rates at 1, 2, 3, 4 and 5 years were 93%, 82%, 68%, 59% and 51%, respectively. The cumulative local recurrence rates for the main tumour at 1, 2, 3, 4 and 5 years were 18%, 22%, 25%, 28% and 28%, respectively. The cumulative new tumour recurrence rates at 1, 2, 3, 4 and 5 years were 24%, 40%, 43%, 60% and 62%, respectively. CT-guided single high-dose PAI is safe and effective for the treatment of SHCC after long-term follow-up.

Minimally invasive application of thrombin in the treatment of pseudoaneurysms following open aortic surgery

Anastomotic leaks are uncommon complications following aortic surgery. To avoid the morbidity associated with a second surgical procedure, minimally invasive techniques have become increasingly popular. To evaluate the feasibility and safety of thrombin in interventional treatment of postoperative pseudoaneurysms. CT-guided percutaneous injection was chosen in four cases. Endovascular access using an occlusion balloon catheter placed in the orifice of the pseudoaneurysm was utilized in one case. The average volume of all pseudoaneurysms was 178 ± 190 mL with a volume of the patent lumen of 25 ± 28 mL. All aneurysms thrombosed after injection of 600 ± 237 IU of thrombin. During the follow-up period of an average of 10 months all pseudoaneurysms remained occluded. Our series demonstrates the feasibility of thrombin in the treatment of aortic anastomotic pseudoaneurysms. In combination with occlusion balloon catheters, even wide-necked pseudoaneurysms may be treated successfully. However, further investigations are warranted.

Medium-term, long-term efficacy of collagenase injected to target site by CT-guided in treatment for lumbar disc herniation

Objective To explore medium-term,long-term efficacy of collagenase injected to target site by CT-guided in treatment for lumbar disc herniation. Methods 50 patients with lumbar disc protrusion were treated with CT-guided percutaneous injection of collagenase accurately reaching prominence(target site). Results All patients were followed up 36 to 60 months. The total effective rate was 82.97% (more than 36 months)and82.23%(more than 60 months). Conclusion Grasping indications well, CT-guided percutaneous injection of collagenase target site in treatment of lumbar disc herniation was accurate, safe, simple, effective, and was the preferred treatment for such patients. Key words: Intervention; Collagenase; Lumbar disc lysis; Lumbar disc herniation

Percutaneous transcatheter arterial embolization of inferior pancreatico‐duodenal artery aneurysms associated with celiac artery stenosis or occlusion

To report our experience with percutaneous TAE of true IPDA aneurysms. Most IPDA aneurysms are ruptured at presentation causing a high mortality risk. Minimally invasive treatment approaches may improve overall outcomes in such patients. Between 1996 and 2007, seven patients (5 Males; mean age 55 y) with symptomatic IPDA aneurysms and severe degree (>75%) celiac artery stenosis were treated with percutaneous TAE. The medical and imaging records were reviewed for demographics, clinical presentation, treatment, complications and follow-up. Patients presented with epigastric pain (7/7), hemodynamic shock (2/7) and rectal bleeding (2/7). Selective catheter angiography was performed in all patients with the intent to embolize the aneurysms. A total of nine aneurysms were seen in seven patients. Two patients had two aneurysms each. The aneurysms ranged in size from 0.5 to 4.0 cm (mean 1.9 cm). Trans-catheter coil embolization was successful in 8/9 (89%) aneurysms in 6 patients. Following unsuccessful TAE of one aneurysm in one of the patient, the aneurysm was treated successfully with direct CT-guided percutaneous transabdominal injection of N-butyl-2-cyanoacrylate. There were no complications on follow up. Angioplasty and stenting of the celiac artery were performed in one patient for complete occlusion. None of the patients developed clinical or imaging evidence of visceral ischemia following embolization. None had recurrent symptoms during clinical follow-up (median 3 years, range 0.5-13.5 years). Follow-up CT (Median 6.6 months, range 4 days-11.5 years) in all patients showed no recurrence of the aneurysm. IPDA aneurysms associated with celiac axis stenosis can be successfully treated with percutaneous embolization with minimal recurrence.

Postoperative annular pseudocyst: report of two cases with an unusual complication after microdiscectomy, and successful treatment by percutaneous aspiration and steroid injection

Background context After microdiscectomy for extruded disc fragments, patients may develop recurrent symptoms from numerous causes. Postoperative annular pseudocysts represent a unique entity not previously described in the medical literature. Purpose To report unique imaging findings in two patients who presented with recurrent radiculopathic symptoms after microdiscectomy. To report successful percutaneous aspiration and steroid injection in one of these cases. Study design/setting Report of two cases. Methods Two patients underwent preoperative imaging with noncontrast magnetic resonance imaging (MRI) and postoperative imaging with pre- and postcontrast MRI. One of these patients underwent therapeutic computed tomography (CT)-guided aspiration and injection. Results MRI demonstrated T2 hyperintense and enhancing collections, which conformed to the shape of the resected disc fragment and communicated with the disc annulus. One of these cases demonstrated enlargement over several months with worsening of symptoms. Aspiration of the lesion produced thick fluid. The patient experienced marked relief of symptoms after the aspiration and injection of steroid into the lesion. Conclusions The unique imaging findings in these patients represent a previously undescribed complication of microdiscectomy, which we have termed “postoperative annular pseudocyst.” We have successfully treated one case with CT-guided percutaneous aspiration and injection.

CT-Guided Percutaneous Steroid Injection for Management of Inflammatory Arthropathy of the Temporomandibular Joint in Children

The purposes of this study were to retrospectively review an injection technique, to develop a grading system for evaluation of imaging findings, and to report preliminary outcome related to percutaneous CT-guided steroid injection into the temporomandibular joints of children with inflammatory arthropathy. CT-guided steroid injection into the temporomandibular joint of children with inflammatory arthropathy results in clinical and imaging improvement in a substantial proportion of children treated.

Intralesional Injection of Absolute Alcohol Into Symptomatic Vertebral Hemangiomas

The management of vertebral hemangiomas remains controversial. This report describes the successful management of spinal cord compression caused by an intraosseous and extraosseous vertebral hemangioma with the percutaneous injection of absolute alcohol. A 71-year-old woman presented with lower extremity weakness and sensory disturbance. Magnetic resonance imaging and computed tomography (CT) confirmed the presence of a vertebral hemangioma involving the Th11 vertebral body. A CT-guided percutaneous transpedicular injection of absolute alcohol into the affected vertebral body resulted in symptomatic and imaging improvement. CT-guided percutaneous transpedicular injection of absolute alcohol into symptomatic vertebral hemangiomas is a simple, safe, and effective technique for relieving compression and devascularizing the hemangioma.

CT-guided percutaneous ethanol injection of the thymus for treatment of myasthenia gravis.

This study was designed to validate the therapeutic effectiveness of CT-guided percutaneous ethanol injection of the thymus for the treatment of myasthenia gravis. The subjects were 45 patients with myasthenia gravis. The diagnosis was determined by the patients' histories, physical findings, neostigmine tests, and morphologic changes. According to the Osserman classification, the 45 patients with myasthenia gravis were classified as stage I (n = 26), stage III (n = 13), and stage IV (n = 6). A 21- or 22-gauge needle was inserted into the thymus under CT guidance, and then ethanol was injected step by step until it was distributed throughout the whole thymoma, the hyperplasia of the thymus, or the normal thymus. The amount of ethanol injected ranged from 2 to 13 mL, with a mean of 7 mL. CT follow-up at 3-4 weeks showed that the thymus or thymoma was completely or mostly necrotized. CT follow-up at 3 months showed that the vertical, transverse, and anteroposterior dimensions of the thymus in all 45 myasthenia gravis patients decreased by 59.2%, 68.6%, and 73.2%, respectively, compared with those before percutaneous ethanol injection treatment. The therapeutic effect was observable clinically 2 days after treatment in 44 patients, including 36 patients who were able to open their eyes after treatment. A 5-year follow-up study showed that the condition markedly improved in 35 patients, improved in nine patients, and failed to improve in one patient who did not respond to the treatment. After treatment, 37 patients presented with low-grade fever (range, 37.3-37.7 degrees C; mean, 37.5 degrees C), which resolved 3 days later without treatment; all 45 patients complained of mild retrosternal pain after ethanol injection. The therapeutic effect of CT-guided percutaneous ethanol injection into the thymus of patients with myasthenia gravis is definite. This procedure is safe and has low morbidity. CT-guided percutaneous ethanol injection is a minimally invasive alternative treatment for myasthenia gravis.