CT-guided Percutaneous Puncture Research Articles

Searching Method for Three-Dimensional Puncture Route to Support Computed Tomography-Guided Percutaneous Puncture.

In CT-guided percutaneous punctures-an image-guided puncture method using CT images-physicians treat targets such as lung tumors, liver tumors, renal tumors, and intervertebral abscesses by inserting a puncture needle into the body from the exterior while viewing images. By recognizing two-dimensional CT images prior to a procedure, a physician determines the least invasive puncture route for the patient. Therefore, the candidate puncture route is limited to a two-dimensional region along the cross section of the human body. In this paper, we aim to construct a three-dimensional puncture space based on multiple two-dimensional CT images to search for a safer and shorter puncture route for a given patient. If all puncture routes starting from a target in the three-dimensional space were examined from all directions (the brute-force method), the processing time to derive the puncture route would be very long. We propose a more efficient method for three-dimensional puncture route selection in CT-guided percutaneous punctures. The proposed method extends the ray-tracing method, which quickly derives a line segment from a given start point to an end point on a two-dimensional plane, and applies it to three-dimensional space. During actual puncture route selection, a physician can use CT images to derive a three-dimensional puncture route that is safe for the patient and minimizes the puncture time. The main novelty is that we propose a method for deriving a three-dimensional puncture route within the allowed time in an actual puncture. The main goal is for physicians to select the puncture route they will use in the actual surgery from among the multiple three-dimensional puncture route candidates derived using the proposed method. The proposed method derives a three-dimensional puncture route within the allowed time in an actual puncture. Physicians can use the proposed method to derive a new puncture route, reducing the burden on patients and improving physician skills. In the evaluation results of a computer simulation, for a 3D CT image created by combining 170 two-dimensional CT images, the processing time for deriving the puncture route using the proposed method was approximately 59.4 s. The shortest length of the puncture route from the starting point to the target was between 20 mm and 22 mm. The search time for a three-dimensional human body consisting of 15 CT images was 4.77 s for the proposed method and 2599.0 s for a brute-force method. In a questionnaire, physicians who actually perform puncture treatments evaluated the candidate puncture routes derived by the proposed method. We confirmed that physicians could actually use these candidates as a puncture route.

A comparative study of establishing rabbit vertebral tumor model by two ways of CT-guided percutaneous puncture

ObjectiveTo investigate the difference of tumor formation rate of rabbit vertebral tumor model established by percutaneous injection of V×2 tumor tissue suspension and tumor mass under computed tomography (CT) guidance, and the imaging findings of CT, magnetic resonance images (MRI) and positron emission tomography with computed tomography (PET/CT) at 7 days, 14 days and 21 days after implantation, and preliminarily verify the safety and feasibility of microwave ablation (MWA), percutaneous vertebroplasty (PVP) and microwave ablation combined with percutaneous vertebroplasty (MWA + PVP) in rabbit VX2 vertebral tumor model. MethodsThirty healthy New Zealand rabbits were randomly allocated to tissue suspension group and tumor block group, with 15 rabbits for each group. The VX2 tumor block and mixed suspension were inoculated into the L5 vertebral body under CT-guided percutaneous puncture. The PET/CT, MRI and CT examinations were performed at 7, 14 and 21 days after implantation. Fisher exact probability test was used to compare the success rate of the two implantation methods and the tumor display rate at each time point of the three examination methods. Observe the paralysis of tumor-forming rabbits, and immediately perform MWA/PVP/MWA + PVP treatment according to groups after paralysis to verify the safety and feasibility of treatment. ResultsA total of 18 experimental rabbits were successfully modeled in two groups, of which the success rate was 26.6% (4/15) in tissue suspension group and 93.3% (14/15) in tumor block group, with statistically significant differences between two groups (P < 0.01). The tumor display rates by PET/CT, MRI and CT at each time point after implantation were: 83.3% (15/18), 16.6% (3/18), and 0% (0/18) at 7 days after implantation; 100% (18/18), 88.8% (16/18), and 11.1% (2/18) at 14 days after implantation; and 100% (18/18), 100% (18/18), 77.7% (14/18) at 21 days after implantation. The average paralysis time of 18 experimental rabbits successfully modeled was 24.44 ± 2.38 days, and MWA/PVP/MWA + PVP treatment was performed in groups immediately after paralysis. Except for 2 rabbits who died due to anesthesia overdose during anesthesia before treatment, the remaining 16 rabbits were successfully treated with MWA/PVP/MWA + PVP, and the technical success rate was 100% (16/16). In MWA group, one experimental rabbit was randomly selected and killed after ablation, and histopathological examination (H and E staining) was performed together with 2 experimental rabbits who died of anesthesia. The pathological changes before and after ablation were compared. The survival time of the remaining 15 experimental rabbits varied from 3 to 8 days after treatment. ConclusionThe success rate of establishing rabbit vertebral tumor model by injecting tumor masses under the CT-guided percutaneous puncture is high, and the following MWA and PVP treatment can be successfully conducted. PET/CT is the most sensitive method for early detection of tumor compared with MRI and CT. Spectral Presaturation with Inversion Recovery (SPIR) sequence can significantly improve the detection rate of smaller tumors by MRI and shorten the detection time.

The diagnostic value of CT-guided percutaneous puncture biopsy of pulmonary ground-glass nodules: a meta-analysis.

More and more pulmonary ground-glass nodules (GGNs) are screened with the extensive usage of low-dose computed tomography (CT). The need of CT-guided percutaneous puncture biopsy of GGN remains controversial. To explore the diagnostic accuracy of CT-guided percutaneous puncture biopsy of GGNs. We searched PubMed, EMBASE, the Cochrane Library, and CNKI. Included studies reported the puncture biopsy results of pulmonary GGNs, including the number of true positive (TP), false positive (FP), true negative (TN), and false negative (FN) cases. After evaluating the studies, statistical analysis, and quality assessment, the pooled diagnostic sensitivity (SEN), specificity (SPE), and diagnostic odds ratio (DOR) were calculated. The summary receiver operating characteristic (SROC) curve was constructed and the area under the curve (AUC) was calculated. Subgroup analysis was performed according to whether spiral CT or fluoroscopy-guided CT was used in the study. This meta-analysis included 14 studies with a total of 759 patients (702 samples). The pooled SEN, SPE, and DOR of CT-guided puncture biopsy of pulmonary GGNs were 0.91 (95% confidence interval [CI] = 0.89-0.94), 0.99 (95% CI = 0.95-1.00), and 138.72 (95% CI = 57.98-331.89), respectively. The AUC was 0.97. Our results indicated that CT-guided puncture biopsy of GGNs has high SEN, SPE, and DOR, which proved that CT-guided puncture biopsy was a good way to determine the pathological nature of GGN.

Virtual navigation bronchoscopy-guided intraoperative indocyanine green localization in simultaneous surgery for multiple pulmonary nodules.

BackgroundAccurate localization of pulmonary nodules is the main difficulty experienced in wedge resection. Commonly used localization methods have their own advantages and disadvantages. However, clinical work has demonstrated that intraoperative indocyanine green localization under electromagnetic navigation bronchoscopy/virtual navigation bronchoscopy (VNB) is more advantageous than conventional methods for patients with multiple pulmonary nodules undergoing simultaneous surgery, especially for those undergoing bilateral lung surgery.MethodsData of patients undergoing simultaneous surgery for multiple pulmonary nodules with preoperative methylene blue localization by computed tomography (CT)‐guided percutaneous lung puncture (methylene blue group) or intraoperative indocyanine green localization under VNB (virtual navigation group) were retrospectively analyzed. Patient characteristics, pulmonary nodule features, localization time, preoperative location time, location success rate, operation time, complication incidence, visceral pleural staining rate after localization, and pulmonary nodule primary resection success rate were compared between the two groups.ResultsThe methylene blue and virtual navigation groups comprised 39 and 20 patients with 119 and 67 pulmonary nodules resected, respectively. Sex, age, number of pulmonary nodules resected simultaneously, unilateral/bilateral lung surgery, pulmonary nodule size, distance between pulmonary nodules and the visceral pleura, pulmonary nodule consolidation‐to‐tumor ratio, location of pulmonary nodules in the pulmonary lobe, postoperative pathology, visceral pleura staining rate, primary pulmonary nodule resection success rate, and surgical duration did not differ significantly between the groups (p > 0.05). The localization time of the virtual navigation group was significantly shorter than that of the methylene blue group (p < 0.05), regardless of unilateral or bilateral multiple nodules. In the methylene blue group, 25.64% (10/39) of patients presented complications, all of which were pneumothorax, whereas no complications were found in the virtual navigation group.ConclusionsFor patients with multiple pulmonary nodules undergoing simultaneous surgery, indocyanine green injection under VNB can achieve a similar effect on pulmonary nodule localization as classical methylene blue injection under CT‐guided percutaneous lung puncture, with shorter localization time and fewer complications.

Extracranial Non-Gasserian Ganglion Application of Radiofrequency Thermocoagulation on the Mandibular Branch of the Trigeminal through the Foramen Ovale for Trigeminal Neuralgia

Percutaneous radiofrequency ablation (RFA) of the trigeminal Gasserian ganglion via the foramen ovale is still one of the classic treatments for primary trigeminal neuralgia. However, the Gasserian ganglion is deep in the middle cranial fossa. Although it is a structure outside the brain tissue, the puncture needle must enter the encephalic to reach the Gasserian ganglion and so it is difficult to completely avoid the risk of intracranial hemorrhage and infection caused by puncture damage to intracranial blood vessels. It is not clear whether if it is possible for RFA at the extracranial non-gasserian-ganglion site via the exit of the cranial channel (foramen ovale) for patients with V3 trigeminal neuralgia (TN). Prospective, clinical research study. Department of Anesthesiology and Pain Medical Center, Jiaxing, China. One hundred and seven patients with isolated mandibular branch trigeminal neuralgia were included. Radiofrequency thermocoagulation was performed by CT-guided percutaneous puncture through the foramen ovale. The puncture target was the midpoint of the horizontal transverse diameter of the oval foramen. If the tingling sensation in the mandibular nerve innervation area could be detected, the radiofrequency thermocoagulation (90°C, 120 sec) under intravenous anesthesia would be performed. We investigated the inclination angle, puncture angle and depth, puncture operation time, intraoperative complications and short-term and long-term results after operation. After radiofrequency thermocoagulation, the pain in the mandibular branch dominant area was completely diminished in 104 patients. Two patients were cured after the second radiofrequency treatment. No intracranial hemorrhage not infection complications occurred, except for facial hematoma during operation in 21 cases. After 12-24 months of follow-up, 9 patients had recurrence and were still effective after receiving additional extracranial radiofrequency treatment. A control group should be established and more clinical data should be collected in future work. Extracranial non-Gasserian-ganglion RF can achieve satisfactory results and improve the safety of radiofrequency treatment for trigeminal neuralgia.

Human Cadaveric Artificial Lung Tumor-Mimic Training Model.

Introduction: An important phase in surgical training is gaining experience in real human anatomical situations. When a cadaver is available it may complement the various artificial practice models. However, it is often necessary to supplement the characteristics of the cadavers with a simulation of a tumor. Our objective was to develop an easy-to-create, realistic artificial tumor-mimic model for peripheral lung tumor resection practice. Methods: In our work we injected barium sulphate enriched silicone suspension into 10 isolated, non-fixed lungs of human cadavers, through the puncture of the visceral pleura. Four lesions–apical, hilar and two peripheral–were created in each of ten specimens. After fixation CT scans were obtained and analyzed. The implanted tumor-mimics were examined after anatomical preparation and slicing. Also performed CT-guided percutaneous puncture was also performed to create the lesions in situ in two lungs of human cadavers. Results: Analyzing the CT data of 10 isolated lungs, out of 40 lesions, 34 were nodular (85.0%) and in the nodular group five were spiculated (12.5%). Satellite lesions were formed in two cases (5.0%). Relevant outflow into vessels or airway occurred in five lesions (12.5%). Reaching the surface of the lung occured in 11 lesions (27.5%). The tumor-mimics were elastic and adhered well to the surrounding tissue. The two lesions, implanted via percutaneous puncture, both were nodular and one also showed lobulated features. Conclusion: Our artificial tumor-mimics were easy to create, varied in shape and size, and with percutaneous implantation the lesions provide a model for teaching every step of a surgical procedure.

Feasibility and safety of fine positioning needle-mediated breathing control in CT-guided percutaneous puncture of small lung/liver nodules adjacent to diaphragm

To assess the efficacy, safety, and feasibility of a separate inserted positioning fine needle-mediated breathing-control technique applied to computed tomography (CT)-guided percutaneous puncture for biopsy or microwave ablation (MWA) of small lung/liver nodules near diaphragm. Total 46 patients with pulmonary/liver small nodules (≤ 3 cm in size) near diaphragm(nodule within 1 cm distance to the diaphragm)were undergone percutaneous biopsy ( n = 15) or MWA (n = 31) under the guidance of CT, and a separate positioning fine needle-mediated breathing-control technique was applied for the precise punctures. CT plain scan was performed to monitor the complications after the procedure. The patient baseline data, operation details, successful rate, major complications as well as radiation dose during the procedure were recorded and analyzed. With the assistance of a fine positioning needle insertion for controlling the breathing, the puncture success rate for biopsy or MWA reached 91.30% (42/46). For biopsy, the mean nodule diameter, nodule distance to the diaphragm, puncture time and radiation dose during CT scan were 2.27 cm ± 0.74, 0.61 cm ± 0.24, 18.67 min ± 6.23, 28.84 mSv ± 6.99, respectively; For MWA, the mean nodule diameter, nodule distance to the diaphragm, puncture time and CT radiation dose were 2.35 cm ± 0.64, 0.69 cm ± 0.23, 38.71 min ± 13.65, 33.02 mSv ± 8.77, respectively. Totally, there were three and four cases found minimal puncture-related hemoptysis and pneumothorax needed no additional treatments, respectively. We recently developed and verified a feasible, safe and highly effective puncture technique with reasonable radiation dose for CT-guided biopsy or MWA for small nodules abutting diaphragm, therefore worthy of extensive application to similar clinical situations.

CT-guided Percutaneous Lung Puncture for the Diagnosis of Solid Pulmonary Nodules: A Single-center Experience Summary

背景与目的探究经皮肺穿刺对于实性肺小结节（直径≤15 mm）的诊断价值。方法本研究回顾性地纳入了2014年1月-2018年12月于本中心行经皮肺穿刺的20例实性肺小结节患者，其中男性11例，女性9例。病灶最大直径介于0.5 cm-1.5 cm之间，排除严重脏器功能不全，有凝血障碍患者。结果20例患者全部取材成功，19例患者均获得明确的病理诊断，其中11例患者找到恶性肿瘤细胞，明确为肺恶性肿瘤，5例为肺慢性炎，2例纤维组织增生，1例找到肺软骨组织，1例未见肿瘤细胞。穿刺后少量气胸1例，穿刺侧少量胸腔积液患者1例。结论经皮肺穿刺对于实性肺小结节的诊断具有较高的有效性以及安全性。

CT-guided versus ultrasound-guided percutaneous lung puncture biopsy in the diagnosis of peripheral pulmonary masses: a Meta-analysis

Objective To systematically evaluate the efficacy and safety of CT-guided percutaneous lung puncture biopsy versus ultrasound-guided percutaneous lung puncture biopsy. Methods Relevant domestic and foreign related databases such as PubMed, Web of Science, Cochrane Library, OVID, China Biology Medicine, VIP, Wanfang and CNKI databases were searched, the randomized controlled trial about the applications of CT-guided and ultrasound-guided percutaneous lung puncture biopsy were collected. After extracting the relevant data, a Meta-analysis was performed using RevMan 5.2 and Stata softwares. Results Ten studies met the inclusion criteria, with a total sample size of 1 158 cases, of which 635 were CT-guided puncture biopsy and 523 were ultrasound-guided puncture biopsy. Meta-analysis showed that the difference of the success rate between the CT-guided group and the ultrasound-guided group was not statistically significant [97.48% (619/635) vs. 96.56% (505/523), RR= 1.01, 95% CI 0.99-1.03, P= 0.360]; the puncture diagnosis rate in the CT-guided group was lower than in the ultrasound-guided group, and the difference was statistically significant [92.44% (619/635) vs. 96.56% (505/523), RR= 0.97, 95% CI 0.94-0.99, P= 0.007]. The total incidence of complications after puncture in the CT-guided group was higher than that in the ultrasound-guided group, and the difference was statistically significant [14.49% (92/635) vs. 9.56% (50/523), RR= 1.56, 95% CI 1.11-2.19, P= 0.010]; the incidence of pneumothorax after puncture in the CT-guided group was higher than that in the ultrasound-guided group, and the difference was statistically significant [11.50%(73/635) vs. 6.31% (33/523), RR= 1.77, 95% CI 1.17-2.68, P= 0.007]; the difference of the incidence of bleeding after puncture between the CT-guided group and the ultrasound-guided group was not statistically significant [2.99% (19/635) vs. 3.25% (17/523), RR= 1.08, 95% CI 0.59-1.98, P= 0.800]. Conclusions Both CT-guided and ultrasound-guided percutaneous lung puncture biopsy have good clinical diagnostic value. However, for the intrapulmonary masses shown by ultrasound, the ultrasound-guided lung puncture biopsy has a shorter operation time, lower cost, and higher safety. Key words: Biopsy; Punctures; Ultrasonogrophy; Computed tomography; Peripheral pulmonary masses; Meta-analysis

Computed Tomography (CT)-Guided Percutaneous Thoracic Sympathetic Chain Radiofrequency Thermocoagulation for Raynaud Disease.

BACKGROUND We introduce a minimally invasive technique for the treatment of Raynaud disease - CT-guided percutaneous thoracic sympathetic chain radiofrequency thermocoagulation. MATERIAL AND METHODS Under CT guidance, the radiofrequency needle was punctured from the upper edge of the costotransverse joint to the anterior superior edge of the 4th capitulum costae and the lateral parietal pleura. After sensorial (1.5 mA, 50 Hz) and motorial (1.5 mA, 2Hz) testing to determine that there was no nerve innervation zone with muscle numbness and twitches, radiofrequency coagulation was set at 95°C for 300 s. RESULTS A total of 17 patients were enrolled in the treatment group. All the patients underwent CT-guided percutaneous thoracic sympathetic chain puncture of the needles to the upper edge of the 4th capitulum costae on both sides. The perfusion index (PI) of the fingers began to rise 30 s after radiofrequency thermocoagulation, and the palm temperature (T) began to rise after 90 s. At the end of treatment, PI increased by an average of 4.6-fold, and the T average rose by 3.6°C. Postoperative cold-water stimulation testing could no longer induce Raynaud disease. Follow-up was conducted for 1 to 15 months. Two patients were found to have recurrence at 9 months and 13 months, respectively. CONCLUSIONS CT-guided percutaneous thoracic sympathetic nerve chain radiofrequency coagulation can effectively treat Raynaud disease.

CT-guided thoracic sympathetic blockade for palmar hyperhidrosis: Immediate results and postoperative quality of life

The purpose of this study was to evaluate the results, complications, and degree of satisfaction among patients who underwent a CT-guided percutaneous puncture thoracic sympathetic blockade. A total of 186 patients underwent CT-guided thoracic sympathetic blockade based on case histories and a prospective pre- and postoperative questionnaire survey. The study sample was composed of 93 patients with an age range from 18 to 34years and a diagnosis with primary palmar hyperhidrosis (severe in some patients). Percutaneous puncture thoracic sympathetic blockade guided by CT was performed under local anesthesia in all patients. Heart rate (HR), non-invasive blood pressure (NIBP), arterial oxygen saturation (SPO2), perfusion index (PI), and palmar temperature (T) were monitored before and after treatment. Follow-up included a questionnaire on life quality and degree of satisfaction. Ten minutes after treatment, the SPO2, PI, and temperature all raised remarkably ([92.75±2.02]% vs. [98.85±1.09]%, [1.55±0.69]% vs. [8.60±0.94]%, [30.95±1.27]°C vs. [35.75±0.55]°C, respectively, P<0.001). The therapeutic success rate was 96.7%. No operative mortality was recorded. No complications were observed, except transient bradycardia in one patient and transient injection site pain in 25 patients. Of the 89 patients who were monitored over a period of 6–12months through follow-up interviews and questionnaires, 46% developed compensatory hyperhidrosis, 87.6% reported improvement in their quality of life. CT-guided percutaneous puncture thoracic sympathetic blockade is a safe, effective, and minimally invasive technique for the treatment of palmar hyperhidrosis. Despite the high rate of compensatory hyperhidrosis, it produces a high rate of patient satisfaction.

Stepwise Therapy for Treating Tuberculosis of the Upper Cervical Spine: A Retrospective Study of 11 Patients

Aims: Tuberculosis of the upper cervical spine is a rare occurrence with serious consequence, and its optimal treatment protocol remains inconclusive. This study aims at investigating the clinical characteristics and management outcomes of the stepwise therapy for different stages of tuberculosis of the upper cervical spine. Methods: We conducted a retrospective analysis of 11 patients with tuberculosis of the upper cervical spine who received anti-tuberculosis chemotherapy for 15 months. Two infants were treated by individualized chemotherapy, while 9 patients with retropharyngeal abscess were first treated with CT-guided percutaneous puncture, and the catheter was used to administer local chemotherapy. Two of these 9 patients continued to receive posterior instrumentation due to atlantoaxial subluxation. Patients were followed up clinically and radiologically for an average period of 60 months. Results: Two patients underwent catheter change due to catheter falling off and blockage, 2 patients had gastrointestinal side effects, and 2 patients had drug-induced hepatitis derived from the chemotherapy. Mean erythrocyte sedimentation rate was 10.27 mm/h (range 4-16 mm/h) and average visual analogue scale score was 2.55. A total of 11 cases underwent routine anti-tuberculosis chemotherapy for 15 months. 9 of 11 cases received supplementary surgical therapy, and all patients were cured at the final follow-up. Conclusion: Standard anti-tuberculosis chemotherapy is the cornerstone of stepwise therapy for tuberculosis of the upper cervical spine. Local chemotherapy is effective and minimally invasive for patients with severe local symptoms without spinal cord compression. Just as in patients with atlantoaxial instability, open fixation and bone grafting are necessary.

Treatment of pediatric spinal tuberculosis abscess with percutaneous drainage and low-dose local antituberculous therapy: a preliminary report.

The purpose of this study was to evaluate the outcomes of computed tomography (CT) guidance using percutaneous catheter with low-dose drainage local chemotherapy (modified PCD) and antituberculous therapy (ATT) for the treatment of spinal tuberculosis in children. Twenty-seven children suffering from spinal tuberculosis were treated with modified PCD and ATT in our institute from 2002 to 2012. We describe our treatment, which involves CT-guided percutaneous puncture and local chemotherapy (continuous low-dose (20mL) irrigation). The patients were evaluated based on the Frankel scoring system, the kyphotic Cobb angle, and the erythrocyte sedimentation rate (ESR). All patients were followed up for an average of 31.00 ± 13.94months. No sinus formation was detected. All patients responded well to this treatment. The ESR values were decreased to normal at last follow-up. The neurological functions show significant improvement after operation. Preoperatively, the kyphotic angle was 22.89 ± 7.06°, and it was measured as 21.19 ± 8.73° at the last visit. Our results showed that percutaneous intubation and low-dose irrigation under CT guidance (modified percutaneous catheter drainage (MPCD)) and ATT are easy, safe, efficient, and less invasive methods for the treatment of spinal tuberculosis in children.

Establishing a rabbit spinal tumor model for nonvascular interventional therapy through CT-guided percutaneous puncture inoculation.

An animal spinal tumor model is needed to better simulate the clinical situation and to allow percutaneous puncture, which may provide an experimental platform for the new nonvascular interventional therapies. We established a rabbit spinal tumor model through a CT-guided percutaneous puncture inoculation technique for nonvascular interventional therapy. VX2 tumor cells were inoculated into the lumbar vertebrae of 32 rabbits through a CT-guided percutaneous puncture technique; then, the development of hind limb paraparesis was observed in the rabbits twice a day. MR imaging and CT were performed on days 14, 21, and 28 postinoculation and at the development of hind limb paraparesis. On days 21 and 28 postinoculation, 2 rabbits, whose imaging suggested successful modeling without hind limb paraparesis, were chosen on each day. The lumbar vertebrae were sampled from 1 rabbit for histopathologic examination, and the other rabbit underwent PET-CT examination before percutaneous vertebroplasty. Finally the lesion vertebrae were sampled for histopathologic examination. The success rate of modeling was 90.6% (29/32) in our study. On day 21 postinoculation, successful modeling was achieved in 21 rabbits, with 19 having no hind limb paraparesis. On day 28 postinoculation, another 7 achieved successful modeling, and only 1 developed hind limb paraparesis. Percutaneous vertebroplasty treatment was successful for the 2 rabbit models. Establishment of a rabbit spinal tumor model through a CT-guided percutaneous puncture technique and inoculation of VX2 tumor is easy and has a high success rate. The established model can be used to study nonvascular interventional therapies for spinal tumor, including percutaneous vertebroplasty.

Thoracic type Ia endoleak: direct percutaneous coil embolization of the aortic arch at the blood entry site after TEVAR and double-chimney stent-grafts

To introduce a novel percutaneous technique to stop blood entry at the lesser aortic arch curvature by coil embolisation in type Ia endoleak after TEVAR. A 61-year-old Marfan patient presented with type Ia endoleak of the aortic arch and a growing aortic arch pseudoaneurysm after TEVAR. Multiple preceding operations and interventions made an endovascular approach unsuccessful. Direct percutaneous puncture of the aneurysmal sac would have cured the sign, but not the cause of blood entry at the lesser curvature of the aortic arch. Direct CT-guided percutaneous puncture of the blood entry site in the aortic arch with fluoroscopically guided coil embolisation using detachable extra-long coils was successfully performed. Three weeks after the intervention, the patient developed fever because of superinfection of the pseudoaneurysm. The blood cultures and CT-guided mediastinal aspirate were sterile. After intravenous administration of antibiotics, the fever disappeared and the patient recovered. Six-month follow-up showed permanent closure of the endoleak and a shrinking aneurysmal sac. Direct percutaneous puncture of the aortic arch at the blood entry site of a thoracic type Ia endoleak after TEVAR and double-chimney stent-grafts with coil embolisation of the wedge-shaped space between the lesser aortic curvature and the stent-graft is possible. Endoleaks after thoracic endovascular aortic repair are common in 15-30 %. Most endoleaks can be treated by endovascular means. Direct percutaneous endoleak repair is described as a bail-out option. Direct percutaneous aortic arch coil embolisation of type 1a endoleak is possible. Antibiotic prophylaxis should be administered case by case, considering individual risk factors.

The clinical application of CT-guided percutaneous puncture biopsy in diagnosing thyroid nodes

The clinical application of CT-guided percutaneous puncture biopsy in diagnosing thyroid nodes

Treatment of lung lesions by stereotactic body radiation therapy after computed tomography guided placement of a Visicoil® marker: Initial experience

ObjectiveTo describe the technique of stereotactic body radiation therapy (SBRT) of lung lesions after the computed tomography (CT) guided placement of an internal fiducial marker and to assess the results, complications and secondary effects of these procedures. Materials and methodsA series of 39 lesions (8 primary and 31 metastases) in 25 patients treated using this procedure were analyzed. A CT-guided percutaneous transthoracic puncture was performed for placing the internal marker in the lesion or near to it. The procedure did not require sedation.The marker serves as a guide for the treatment of the lesion using SBRT with respiratory synchronism, which allows the movement of the tumor to be controlled and to decrease the radiation volume, giving high doses with precision to the tumor, and minimal to the surrounding healthy tissue. ResultsThe only complication of the percutaneous fiducial placement was a pneumothorax in 6 (24%) patients. A pleural drain had to be placed in 3 patients. Local control was achieved in 96.7% of the lesions. The radiation produced a Grade 1 asthenia in 1 patient, a Grade 2 pneumonitis in one patient and a Grade 1 pneumonitis in the remainder. ConclusionsThe CT-guided placement of internal markers in lung lesions is a safe technique that may be performed as ambulatory procedure. SBRT with respiratory synchronism allows the dose to the tumor to be increased, and reduces the volume of healthy lung treated, with few secondary effects.

MRI拡散強調画像が診断に有用であった多発性嚢胞腎に合併した感染性腎嚢胞の1例

A 56-year-old woman with polycystic kidney disease (PKD) presented with high fever and left back pain. Abdominal computed tomography (CT) scan showed multiple renal cysts, left hydronephrosis and a left ureteral stone. Her condition could not be managed with antibiotic therapy and indwelling left ureteral stent. Infected of left renal cysts was suspected, we performed diffusion-weighted magnetic resonance imaging (MRI). Diffusion-weighted MRI showed higher signal intensity in one renal cyst than in other renal cysts. CT-guided percutaneous puncture of an infected cyst was performed. Her symptoms and fever resolved following the procedure. Identification of an infected renal cyst in PKD is often difficult on either ultrasonography or CT. Diffusion-weighted MRI allowed exact localization of the infected cyst among many cysts in PKD.

Rare pulmonary primitive neuroectodermal tumor metastasizing to the right atrium: a case report

A 28-year-old man complained of intermittent irritable dry cough for 2 months with occasional bloody sputum. Positron emission tomography-computed tomography (PET-CT) suggested multiple heterogeneous soft tissue masses in the inferior lobes of both lungs, with heterogeneous increases in 18F-FDG uptake. No metabolic disorders were found in the rest of the body. CT-guided percutaneous lung puncture and biopsy and immunohistochemical study confirmed pulmonary primitive neuroectodermal tumor (PNET). PNET is characterized by small round blue cells and positive CD99 expression. After six cycles of chemotherapy with ifosfamide, dacarbazine and cisplatin, the lesions diminished substantially. At 2 months after the last cycle of chemotherapy, the patient complained of exertional dyspnea. PET-CT and echocardiogram suggested a space-occupying lesion in the right atrium. Autopsy revealed that this space-occupying lesion had the same pathomorphology and immunophenotype with pulmonary PNET, suggesting metastasis of pulmonary PNET to the right atrium. Here, we reported this rare case of pulmonary PNET metastasizing, instead of direct infiltrating or extending, into the heart.

Tratamiento de lesiones pulmonares mediante radioterapia estereotáxica extracraneal tras colocación guiada por tomografía computarizada de marcador Visicoil®: experiencia inicial

ObjectiveTo describe the technique of stereotactic body radiation therapy (SBRT) of lung lesions after the computed tomography (CT) guided placement of an internal fiducial marker and to assess the results, complications and secondary effects of these procedures. Material and methodA series of 39 lesions (8 primary and 31 metastases) in 25 patients treated using this procedure were analysed. A CT-guided percutaneous transthoracic puncture was performed for placing the internal marker in the lesion or near to it. The procedure did not require sedation.The marker serves as a guide for the treatment of the lesion using SBRT with respiratory synchronism, which allows the movement of the tumour to be controlled and to decrease the radiation volume, giving high doses withe precision to the tumour, and minimal to the surrounding healthy tissue. ResultsThe only complication of the percutaneous fiducial placement was a pneumothorax in 6 (24%) patients. A pleural drain had to be placed in 3 patients. Local control was achieved in 96.7% of the lesions. The radiation produced a grade 1 asthenia in 1 patient, a grade 2 pneumonitis in one patient and a grade 1 pneumonitis in the remainder. ConclusionsThe CT-guided placement of internal markers in lung lesions is a safe technique that may be performed as ambulatory procedure. SBRT with respiratory synchronism allows the dose to the tumour to be increased, and reduces the volume of healthy lung treated, with few secondary effects.