Percutaneous Computed Tomography Research Articles

Cryoablation of osteoid osteomas: Is it a valid treatment option?

Osteoid osteoma is a benign bone tumor with characteristic clinical symptomatology. The selected method for its treatment is percutaneous radiofrequency ablation. However, percutaneous cryoablation is an alternative method with certain advantages. To evaluate percutaneous computed tomography (CT)-guided cryoablation for the treatment of osteoid osteoma in young patients and adults. A total of 25 patients were treated with percutaneous CT- guided cryoablation for osteoid osteomas between October 2020 and March 2023 at a single institution. All patients were above 14-years-old (mean age, 24-years-old), and all procedures were performed under local anesthesia. Of the 25 patients, 8 were female and 17 were male. Tumor sites included the femur (n = 9), medial malleolus (n = 4), sacral ala (n = 4), facets (n = 4), humerus (n = 3), and tibia (n = 1). One cryoprobe was used in each procedure and, when possible, the lesion was covered by the ice-ball using an extraosseous position without penetrating the nidus. All necessary thermal protective techniques were used depending on the anatomical structure at risk. All patients treated had complete response (100% clinical success rate) starting on the day of the procedure. Technical success was achieved in all cases. Visual analog scale (VAS) scores at 1 year were 0, compared to a mean VAS score of 8.5 ± 1 (SD) before the procedure. No recurrences were reported at the 1-year follow-up and no complications were observed. In 11/25 cases, an extraosseous position of the cryoprobe was used with less procedural time achieving technical and clinical success and no complications with less patient discomfort. All patients were discharged from the hospital on the same day as the procedure. Cryoablation of osteoid osteomas is an efficacious and safe procedure with durable clinical results. Its greatest advantage is that the procedure can be performed under local anesthesia using an extraosseous position of the cryoprobe when possible.

Different biopsy techniques for different pancreas graft locations after homolateral simultaneous pancreas-kidney transplantation.

Biopsy of a transplanted pancreas is sometimes necessary in patients who have undergone simultaneous pancreas-kidney (SPK) transplantation and have elevated serum lipase and amylase concentrations. However, the risks associated with pancreatic graft biopsy are high, and the best biopsy technique for different location of pancreatic graft remains unclear. Depending on the anatomical location of the transplanted pancreas, percutaneous computed tomography (CT) combined with color Doppler-guided puncture biopsy or laparoscopic biopsy was used to obtain samples of transplanted pancreatic tissue that were shallow and deep, respectively. After SPK transplantation, 4 patients developed abnormal serum lipase and amylase concentrations and underwent pancreas graft biopsy, 1 patient underwent percutaneous CT combined with color Doppler-guided puncture biopsy, 2 patients underwent laparoscopic wedge biopsy, and 1 patient underwent laparoscopic and puncture biopsy. All biopsies were performed successfully, with no intra- or postoperative complications (e.g., bleeding, pancreatic leakage, intestinal leakage). Biopsy sampling was effective in 3 patients, including 1 case of acute pancreatic rejection, 1 case of pancreatitis, and 1 case of pancreatic plasmablastic lymphoma. Biopsy failed to retrieve samples in 1 patient with a deep pancreatic graft who underwent laparoscopic wedge biopsy. Pancreas graft biopsy is safe and feasible after SPK transplantation. In addition to the two biopsy methods mentioned, other methods can also be used. Different biopsy strategies should be formulated according to the anatomical location of the transplanted pancreas.

Our experience with osteoid osteomas treated by percutaneous radiofrequency ablation

Aim: Evaluating the outcome of computed tomography (CT) guided percutaneous radiofrequency ablation in the treatment of osteoid osteoma in unattainable region. Material and Methods: 12 patients between 12 - 30 years of age with osteoid osteoma were selected and treated by percutaneous CT guided radio-frequency ablation. All the patients had complained of pain. Evaluation done with x-ray, CT, MRI and bone scintigraphy. The lesion is heated to 900 C for a minimum of 6 minutes by Radiofrequency ablation under general anaesthesia. Results: All patients had complete relief of pain after radiofrequency ablation and was fully weight bearing without any support. Local erythema was noted in 6 patients, paresthesia was observed in 2 patients, 1 patients had a small cortical chip fracture at entry site of needle which healed spontaneously and 3 cases of minor thermal injury of skin were noted which required dressing with 0.2% Silver Nitrate ointment. Patients were followed up for 2 years (24 months), and no recurrence was reported. Conclusion: CT guided percutaneous radiofrequency ablation is an effective, minimally invasive and economic treatment method for osteoid osteomas.

CT-guided palladium-103 seed brachytherapy for metastatic adenoid cystic carcinoma: a retrospective study to assess initial safety and effectiveness of percutaneous CT fluoroscopy-guided permanent seed brachytherapy.

PurposeMultiple pulmonary metastases present treatment difficulties in available treatment techniques, which are inconvenient or may damage sufficient pulmonary tissue to cause pulmonary crippling. This retrospective study of a single-community practice evaluated responses to computed tomography (CT)-guided 103Pd permanent seed brachytherapy (CTGPSB) in adenoid cystic carcinoma (ACC) synchronous pulmonary metastases. The purpose of the current study was to document that metastatic pulmonary ACC lesions can be controlled with CTGPSB.Material and methodsTwenty-nine discrete lesions in 14 patients were evaluated with serial CT scans. All were treated with CTGPSB. Lesions were tracked over serial CT scans and volumes measured. Primary endpoint was a reduction in tumor volume on subsequent CT scan. Secondary endpoint was occurrence of CTCAE grades 2-5.ResultsThere was a 100% measured reduction in tumor volume (n = 29) at follow-up. Follow-up was a mean of 3.13 years. Baseline tumor volume was a mean of 1.85 ml (range, 0.69-9.15 ml). There were two grade 1 and one grade 2 adverse events, which did not require hospitalization.ConclusionsCTGPSB for the treatment of multiple ACC pulmonary metastases is effective, with minimal acute complications, as shown in small cohort of subjects of the present study. Further studies evaluating specific dosimetry parameters in this free-hand technique are needed to specify minimal and maximal dose constraints.

Atypical Presentation of Spindle Cell Carcinoma

Spindle Cell Carcinoma (SCC) of the lung is a rare entity. Computed Tomography (CT) and histopathology forms the basis of diagnosis. Here, authors presented a case of a 30-year-old male patient who reported with complaints of painless abdominal swelling associated with shortness of breath and fever. The patient underwent Contrast Enhanced CT (CECT) of chest, abdomen and pelvis with percutaneous CT guided biopsy. The final diagnosis was SCC of lung with transdiaphragmatic spread to abdomen. This case is clinically significant as it depicts unusual spread of SCC presenting as thoracoabdominal mass.

Effectiveness and safety of irreversible electroporation for recurrent hepatocellular carcinoma ineligible for thermal ablation after surgery

ObjectivesTo preliminarily evaluate the clinical effectiveness and safety of computed tomography (CT) image-guided irreversible electroporation (IRE) for the treatment of recurrent hepatocellular carcinoma (HCC) after surgical resection. MethodsFrom January 2016 to February 2018, 18 patients diagnosed with recurrent HCC after surgical resection received IRE under CT image guidance for 22 tumors. Patients were enrolled for IRE when ineligible for thermal ablation due to tumor location. Clinical records and imaging data were reviewed to assess complete ablation rate, local tumor progression free rate (LTPFR), local tumor progression free survival (LTPFS) and complications after a median follow-up time of 14 months. ResultsSuccessful complete ablations were achieved in 20/22 (90.1%) tumors. Mean LTPFS was 10.5 ​± ​9.4 months. Overall 3-, 6- and 12-months LTPFR in 22 tumors following IRE were 68.2% (95% confidence interval [CI]: 45%–83%), 59.1% (95% CI: 33%–76%) and 36.4% (95% CI: 17%–56%), respectively. Complications included pneumothorax (2/18, 11.1%), localized pain (3/18, 16.7%), bile duct dilation (1/18, 5.6%) and transient hypertension (1/18, 5.6%). No major complications or treatment-related deaths were observed. The alpha-fetoprotein levels of two patients decreased to the normal range at 3 and 4 months, respectively. ConclusionsThis study showed that percutaneous CT image-guided IRE can serve as a safe and effective treatment for recurrent HCC not suitable for thermal ablation.

Case Report: Rupture Despite In-Situ Repair of a Secondary Aortoenteric Fistula with Autologous Femoral Veins

Introduction - A secondary aorto-enteric fistula is a direct communication between aorta and intestinal lumen after a reconstructive procedure of the abdominal aorta. Methods - We describe a case of secondary aortoduodenal fistula that occurred eight years following open repair of an abdominal aortic aneurysm. This case illustrates the complexity of the pathology and describes the surgical approach. Results - A 63-year-old man, who underwent an open repair of an aneurysmal abdominal aorta 8 years ago, was referred by infectious diseases because of suspicion of an infected Dacron graft. He was empirically treated with intravenous (IV) antibiotics in another hospital 1 month earlier. Oral antibiotics were continued awaiting further investigations and definitive treatment. One month later he was admitted to the emergency room in sepsis with a proven secondary aorto-enteric fistula on Computed Tomography (CT) angiography and esophagogastroduodenoscopy. An in-situ repair with autologous superficial femoral veins was performed and the defect in the duodenum was closed. Peroperative cultures showed Candida Lusitaniae and Lactobacillus. This procedure was complicated with abscess formation and recurrent sepsis. Percutaneous CT guided drainage and IV antibiotics were successful but after removal of the pigtail, the patient developed acute back pain caused by a pseudoaneurysm noted at the left autologous femoral vein graft. Emergency repair was undertaken with suturing of the aortic stump and extra-anatomic reconstruction with prolonged IV antibiotics and antimycotics. Patient was discharged six weeks after the extra-anatomic reconstruction and the antimycotic therapy will be continued for one year. Conclusion - Despite surgical repair of a secondary aorto-enteric fistula with in-situ replacement with autologous venous material and prolonged antibiotics, this patient still developed a rupture of the venous graft requiring an extra-anatomic reconstruction.

PRIMARY RIGHT ATRIAL CARDIAC ANGIOSARCOMA INITIALLY PRESENTING AS SYNCOPE

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Primary cardiac Angiosarcomas are extremely rare, with incidence of about 0.056% (1). These tumors pose significant diagnostic dilemma due to rarity and varied clinical features at presentation. We report our experience while treating a patient with primary right atrial cardiac angiosarcoma who initially presented with syncope. CASE PRESENTATION: A 45-year-old Spanish woman presented to the emergency room after an episode of syncope. She reported having shortness of breath, sweating and fatigue for 2 weeks prior to the incident. A chest radiograph revealed an enlarged cardiac silhouette, and computed tomography (CT) showed an enhancing mass along the right cardiac border, measuring 4.6 cm by 5.9 cm (Image 1). An Echocardiogram showed a right atrial mass (Image 2) with significant pericardial effusion. Percutaneous CT guided biopsy showed a vascularized mass and the patient underwent an exploratory surgery and removal of tumor. Cytological analysis of the mass failed to provide a diagnosis. 11 months from the surgery, the patient presented with shortness of breath and intense right leg pain. A CT scan of the chest revealed aggressive recurrence of the tumor with cardiac/mediastinal mass invading the right atrium, the right ventricle, the inferior vena cava, the main pulmonary trunk, right middle lobe bronchus and the aorta. There was extensive mediastinal adenopathy as well as right sided pleural effusion (Image 3). There was another mass seen in the right femur and it was biopsied, with a histo-pathological analysis confirming metastatic angiosarcoma. She was started on paclitaxel with a dose of 80 mg/m2 weekly, and tolerated it well. She continues to follow up with Oncology. DISCUSSION: Primary cardiac Angiosarcomas are rare tumors and are usually metastatic at the time of diagnosis. Cardiac Angiosarcomas can present with varying symptoms, these clinical features depend on the tumor size, location, and the extent of the local or distant spread. This tumor affects the right atrium commonly, a feature that is distinct from Atrial Myxoma which usually affects the left atrium. This knowledge can aid clinicians in suspecting an aggressive disease early. Resection, in combination with adjuvant treatment including chemotherapy, radiotherapy, and molecular targeted therapies give the best chance for prolonging survival. Chemotherapeutic regimens include anthracyclines, taxanes or ifosfamide (2). Doxyrubicin based treatments although well known for their cardiotoxic adverse effects have been used as the standard treatment for locally advanced and metastatic disease (3) often with local radiotherapy. CONCLUSIONS: In conclusion, primary Cardiac Angiosarcomas have a rapidly progressive and fatal course with mean survival of 6-11 months from diagnosis. Early diagnosis, with multimodality approach tailored to each patient gives the best chance of prolonged survival. Reference #1: Lam KY, Dickens P, Chan AC. Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies. Arch Pathol Lab Med. 1993 Oct;117(10):1027-31 Reference #2: Schur S, Hamacher R, Brodowicz T. Pazopanib in Primary Cardiac Angiosarcoma of the Right Atrium: A Case Report. Case Reports in Oncology 2016;9(2):363–367. Reference #3: Penel N, Bui BN, Bay J-O, et al. Phase II Trial of Weekly Paclitaxel for Unresectable Angiosarcoma: The ANGIOTAX Study. Journal of Clinical Oncology 2008;26(32):5269–5274. DISCLOSURES: No relevant relationships by Yizhak Kupfer, source=Web Response No relevant relationships by Namrita Malhan, source=Web Response No relevant relationships by Ravikaran Patti, source=Web Response No relevant relationships by Vignesh Ponnusamy, source=Web Response No relevant relationships by Ankur Sinha, source=Web Response No relevant relationships by Parita Soni, source=Web Response

Radiofrequency Ablation for Lung Carcinomas: A Retrospective Review of a High-Risk Patient Population at a Community Hospital

Purpose: The purpose of this study is to retrospectively evaluate the technical efficacy, safety, and treatment outcomes of percutaneous radiofrequency ablation (RFA) of lung tumors in patients not amenable to surgery at an urban community hospital. Materials and Methods: Informed consent and IRB approval was obtained. Eligible tumors were defined as those in patients deemed poor surgical candidates by multidisciplinary consensus or those refusing surgery. Response to treatment was assessed by computed tomography (CT) performed immediately postprocedure and regular intervals up to 36 months later. Complete response was measured as a 30% decrease in mean tumor diameter without evidence of contrast enhancement or tumor growth within the ablation zone as defined by the response evaluation in solid tumors. Patient demographics, technical success, postprocedure complications, and survival were assessed and compared with data available in literature. Results: Twenty-four patients with a total of 29 tumors underwent percutaneous CT guided RFA for biopsy-proven lung malignancies between 2010 and 2016. Complete response was achieved in 82% (14/17) of treated tumors in patients who complied with postprocedure imaging recommendations. Immediate postprocedure complications occurred following 27.6% (8/29) ablations with pneumothorax being the most common, 17.2% (6/29). Mean survival is 28.5 months (95% confidence interval: 19.7–37.3). Progressive disease was seen in 18% (3/17) patients. No immediate treatment mortality was found. No significant difference was found in survival in patients with multiple comorbidities as measured by the Charlson Comorbidity Index. Conclusions: RFA of lung tumors is a well-tolerated procedure with low incidence of minor complications, a good tumor response and survival benefit in selected patients in the community setting. This is a positive endorsement of the potential success of tumor RFA programs outside of the academic setting. In addition, patients with multiple comorbidities should still be considered candidates for RFA as no difference was seen in survival in patients with multiple medical comorbidities.

Percutaneous CT–Guided Sympathicolysis with Radiofrequency for the Treatment of Palmar Hyperhidrosis

PurposeTo evaluate the benefits of computed tomography (CT)–guided percutaneous sympathicolysis with radiofrequency in patients with primary palmar hyperhidrosis (PPHH) in terms of safety, patient satisfaction, and short- and long-term efficacy. Materials and MethodsA total of 139 procedures in 108 patients (mean age, 29.89 y ± 10.94), including 50 men and 58 women, with PPHH and therapy-resistance of nonsurgical treatments were retrospectively analyzed. Treatment was performed bilaterally at T2, T3, and T4 levels, reaching 90°C during 8 minutes. Technical success, immediate efficacy, and presence of complications were analyzed. For follow-up, the Hyperhidrosis Disease Severity Scale was used to evaluate the hyperhidrosis before, at one month, and in the long-term through a survey of 42 patients. Patients' satisfaction and complications were also recorded. ResultsThe technical success rate was 98.56%. The increase in palmar skin temperature was 4.88°C ± 1.85. A total of 85.3% of participants had completely dry hands immediately after treatment. The mean follow-up time was 41.34 months (range, 6–62 mo). One month after treatment, the response rate was 77.38% (P < .001). At long-term follow-up, the response rate was 69.04% (P < .001). Two major complications were observed (1.8%), 52.38% of patients were satisfied, and 59.52% of patients presented compensatory hyperhidrosis at long-term follow-up. ConclusionsPercutaneous CT–guided sympathicolysis is a safe and effective technique for the treatment of PPHH and can be considered as a second choice in patients in whom other nonsurgical therapeutic options have failed, despite the compensatory hyperhidrosis rates.

Computer assisted electromagnetic navigation improves accuracy in computed tomography guided interventions: A prospective randomized clinical trial.

PurposeTo assess the accuracy and usability of an electromagnetic navigation system designed to assist Computed Tomography (CT) guided interventions.Materials and methods120 patients requiring a percutaneous CT intervention (drainage, biopsy, tumor ablation, infiltration, sympathicolysis) were included in this prospective randomized trial. Nineteen radiologists participated. Conventional procedures (CT group) were compared with procedures assisted by a navigation system prototype using an electromagnetic localizer to track the position and orientation of a needle holder (NAV group). The navigation system displays the needle path in real-time on 2D reconstructed CT images extracted from the 3D CT volume. The regional ethics committee approved this study and all patients gave written informed consent. The main outcome was the distance between the planned trajectory and the achieved needle trajectory calculated from the initial needle placement.Results120 patients were analyzable in intention-to-treat (NAV: 60; CT: 60). Accuracy improved when the navigation system was used: distance error (in millimeters: median[P25%; P75%]) with NAV = 4.1[2.7; 9.1], vs. with CT = 8.9[4.9; 15.1] (p<0.001). After the initial needle placement and first control CT, fewer subsequent CT acquisitions were necessary to reach the target using the navigation system: NAV = 2[2; 3]; CT = 3[2; 4] (p = 0.01).ConclusionThe tested system was usable in a standard clinical setting and provided significant improvement in accuracy; furthermore, with the help of navigation, targets could be reached with fewer CT control acquisitions.

Pulmonary Intraparenchymal Blood Patching Decreases the Rate of Pneumothorax-Related Complications following Percutaneous CT–Guided Needle Biopsy

PurposeTo investigate whether an autologous intraparenchymal blood patch (IPB) reduces the rate of pneumothorax-related complications associated with computed tomography (CT)–guided lung biopsies. Materials and MethodsThis study included 834 patients: 482 who received an IPB and 352 who did not. Retrospective review was performed of all CT–guided lung biopsies performed at a single institution between August 2006 and September 2013. Patients were excluded if no aerated lung was crossed. The rate of pneumothorax, any associated intervention (eg, catheter placement, aspiration), chest tube placement, and chest tube replacement requiring hospital admission were compared by linear and multiple regression analysis. ResultsPatients who received an IPB had a significantly lower rate of pneumothorax (145 of 482 [30%] vs 154 of 352 [44%]; P < .0001), pneumothorax-related intervention (eg, catheter aspiration, pleural blood patch, chest tube placement; 43 of 482 [8.9%] vs 85 of 352 [24.1%]; P < .0001), and chest tube placement along with other determinants requiring hospital admission (18 of 482 [3.7%] vs 27 of 352 [7.7%]; P < .0001). No complications related to the IPB were noted in the study group. ConclusionsAutologous IPB placement is associated with a decreased rate of pneumothorax and associated interventions, including chest tube placement and hospital admission, after CT–guided lung biopsies, with no evidence of any adverse effects. These results suggest that an IPB is safe and effective and should be considered when aerated lung is traversed while performing a CT–guided lung biopsy.

Percutaneous CT fluoroscopy-guided core biopsy of pancreatic lesions: technical and clinical outcome of 104 procedures during a 10-year period.

Background In unclear pancreatic lesions, a tissue sample can confirm or exclude the suspected diagnosis and help to provide an optimal treatment strategy to each patient. To date only one small study reported on the outcome of computed tomography (CT) fluoroscopy-guided biopsies of the pancreas. Purpose To evaluate technical success and diagnostic rate of all CT fluoroscopy-guided core biopsies of the pancreas performed in a single university center during a 10-year period. Material and Methods In this retrospective study we included all patients who underwent a CT fluoroscopy-guided biopsy of a pancreatic mass at our comprehensive cancer center between 2005 and 2014. All interventions were performed under local anesthesia on a 16-row or 128-row CT scanner. Technical success and diagnostic rates as well as complications and effective patient radiation dose were analyzed. Results One hundred and one patients (54 women; mean age, 63.9 ± 12.6 years) underwent a total of 104 CT fluoroscopy-guided biopsies of the pancreas. Ninety-eight of 104 interventions (94.2%) could be performed with technical success and at least one tissue sample could be obtained. In 88 of these 98 samples, a definitive pathological diagnosis, consistent with clinical success could be achieved (89.8%). Overall 19 minor and three major complications occurred during the intra- or 30-day post-interventional period and all other interventions could be performed without complications; there was no death attributable to the intervention. Conclusion CT fluoroscopy-guided biopsy of pancreatic lesions is an effective procedure characterized by a low major complication and a high diagnostic rate.

Initial Experience: Alleviation of Pain with Percutaneous CT–Guided Cryoablation for Recurrent Retroperitoneal Soft-Tissue Sarcoma

PurposeTo evaluate the pain-alleviating effect of computed tomography (CT)–guided percutaneous cryoablation for recurrent retroperitoneal soft-tissue sarcomas (RPSs). Materials and MethodsData from 19 men and 20 women (median age, 50.3 y) with recurrent malignant RPS who underwent percutaneous cryoablation were reviewed retrospectively. A total of 50 tumors were treated by cryoablation, including a single tumor in 29 patients, 2 tumors in 9, and 3 tumors in 1. Adverse events and analgesic outcomes were compared as a function of tumor size (< 10 cm and ≥ 10 cm). Efficacy was assessed based on modified Response Evaluation Criteria In Solid Tumors and progression-free survival (PFS). ResultsGrade 1/2 adverse events included fever (n = 17), emesis (n = 7), frostbite (n = 5), and local pain (n = 4). The median follow-up period and PFS were 18.5 months (range, 12–42 mo) and 13.4 months ± 6.2, respectively. At the end of follow-up, 13 patients had died and 26 were living. The mean severe local pain scores on pretreatment day 1 and posttreatment days 1, 5, 10, 15, 20, and 25 were 7.49, 7.40, 6.51, 5.81, 5.35, 5.04, and 5.44, respectively, and significant differences versus pretreatment (P < .001) were reported for posttreatment days 5–25. Immediate relief occurred more frequently in the small-tumor group (4 of 7; 57.1%; P = .018), whereas delayed relief occurred more frequently in the large-tumor group (17 of 22; 77.3%; P = .030). ConclusionsMinimally invasive percutaneous cryoablation improves local pain and is a feasible treatment for recurrent RPSs.

Percutaneous CT–Guided Cryoablation of the Salivary Glands in a Porcine Model

PurposeTo evaluate the imaging, histologic changes and safety of computed tomography (CT)–guided cryoablation of the parotid glands in a porcine model. Materials and MethodsUnilateral CT–guided parotid gland cryoablation was performed in 5 juvenile miniature pigs. The ablated parotid glands underwent 2 cycles of 10-minute freeze and 5-minute thaw using three 17-g cryoprobes. The animals were monitored daily for complications including pain, frostbite, infection, and sialocele or fistula formation. Follow-up CT was performed at 6 weeks postcryoablation. Pathologic evaluation was performed on 2 of the ablated parotid glands. ResultsAll cryoablations in 5 right parotid glands, with 3 sites in each gland, were technically successful. No symptoms suggestive of facial nerve damage were observed during 6-week follow-up. One pig developed an infected sialocele, which was treated with percutaneous drainage and oral antibiotic therapy. No CT evidence of sialocele or other abnormality was identified at the 6-week follow-up in all pigs. Histologic evaluation was performed on 2 of the parotid gland specimens, 1 with the treated sialocele, and 1 of the remaining pigs without sialocele. Both glands demonstrated postprocedural intraglandular lymph nodes and reactive changes without evidence of sialocele or abscess on histopathology. ConclusionsCryoablation of parotid glands was technically feasible in a porcine model. Only 1 pig developed sialocele, which was successfully treated. Further research is warranted to determine the potential use of salivary gland cryoablation to treat patients with drooling.

Unrecognized osteoid osteoma of the proximal femur with associated cam impingement.

Femoro-acetabular impingement is a common cause of hip pain in young athletes. Evaluation typically includes radiographs and magnetic resonance imaging. It is important to appreciate uncommon diagnoses and the role of complimentary imaging. This clinical vignette emphasizes the need complete imaging with CT in select case of atypical hip pain.We present a 19-year old soccer player who underwent seemingly successful arthroscopic FAI surgery but returned with pain. Computed tomography (CT) revealed osteoid osteoma of the lesser trochanter. The lesion was successfully treated with percutaneous CT guided radiofrequency ablation.

Minimally invasive CT guided treatment of intraspinal synovial cyst

BackgroundIntraspinal synovial cysts of vertebral facet joints are uncommon cause of radicular pain as well as neurological deficits. They can be managed both conservatively and surgically.Case reportA 77-year old polymorbid patient presented with bilateral low back pain which worsened during the course of time and did not respond to the conservative treatment. A diagnosis of intraspinal synovial cyst was made using the magnetic resonance imaging (MRI). Percutaneous computed tomography (CT) guided injection with installation of local anesthetic together with corticosteroid and rupture of the cyst was successfully used. A month after the procedure his pain improved, the usage of analgesics diminished and his over-all quality of life improved.ConclusionsPercutaneous CT guided lumbar synovial cyst treatment is safe and reliable alternative to the surgical treatment in polymorbid patients with radiculopathy who are not able to tolerate general anesthesia and operation.

Usefulness of percutaneous cholangiography combined with CT in post-operative patients with hepato-biliary surgery

Hepato-biliary surgery for malignancies has a high mortality rate (7,3%) with also a high rate of readmitted patients within the first 30 days of discharge (14,3- 15,5%) (1). After hepato-biliary surgery medical imaging is essential: computed tomography (CT) is required to detect collections, ultrasonography to assess dilatated biliary ducts and percutaneous cholangiography (PC) to ensure safe withdrawal of biliary drain or Kehr's drain. A recent paper published in the JBR-BTR depicted the interest of double contrast percutaneous transhepatic cholangiographic CT (DCPCT- CT) to explore bile duct obstruction, combining PC and CT with iodine injection (2). We would like to report on our experience with a recent procedure combining PC and CT without iodine injection, demonstrating anastomotic leak in jejunobiliary anastomosis.

Percutaneous ultrasonography and computed tomography guided pancreatic cryoablation: Feasibility and safety assessment

ObjectiveTo assess the safety and feasibility of percutaneous cryoablation on pancreatic cancer via ultrasonography (US) and computed tomography (CT) guidance. Materials and methodsThis retrospective review was approved by the institutional review board and of informed consent. Thirty-two patients (18 men and 14 women; median age 62; age range, 30–77years) with pancreatic cancer (stage II/III/IV, 3/11/18) treated with percutaneous US and CT guided cryoablations between February 2009 and February 2010 were eligible for this review. Thirteen tumors in pancreatic head and 19 in pancreatic body and/or tail measuring 2–11cm (mean, 5.2cm±8 [standard deviation]) were ablated with 49 procedures in total. Feasibility was analyzed by enhanced CT 1–3months post procedure and safety was assessed by clinical signs, symptoms and laboratory results. ResultsNeither procedural death nor serious complications occurred. Fifteen tumors (46.9%) smaller than 5cm were successfully ablated by one session of cryoablation. Twenty-seven patients experienced a ⩾50% reduction in pain score, 22 experienced a 50% decrease in analgesic consumption and 16 experienced a ⩾20 increase in Karnofsky Performance Status (KPS) Score. Partial response (PR) and stable disease (SD) turned up in 9 and 21 patients, respectively, lesions in whom were identified controlled by none enhancement on enhanced CT. Mean and median survival was 15.9 and 12.6months, respectively. The 6-, 12- and 24-month survival rates were 82.8%, 54.7% and 27.3%, respectively. ConclusionUS and CT guided percutaneous cryoablation is a safe and promising local treatment for pancreatic cancer.

Initial Experience with Computed Tomography and Fluoroscopically Guided Placement of Push-Type Gastrostomy Tubes Using a Rupture-Free Balloon Catheter

The purpose of this study was to evaluate the safety and feasibility of percutaneous radiologic gastrostomy placement of push-type gastrostomy tubes using a rupture-free balloon (RFB) catheter under computed tomography (CT) and fluoroscopic guidance. A total of 35 patients (23 men and 12 women; age range 57-93 years [mean 71.7]) underwent percutaneous CT and fluoroscopically guided gastrostomy placement of a push-type gastrostomy tube using an RFB catheter between April 2005 and July 2008. Technical success, procedure duration, and complications were analyzed. Percutaneous radiologic gastrostomy placement was considered technically successful in all patients. The median procedure time was 39±13 (SD) min (range 24-78). The average follow-up time interval was 103 days (range 7-812). No major complications related to the procedure were encountered. No tubes failed because of blockage, and neither tube dislodgement nor intraperitoneal leakage occurred during the follow-up period. The investigators conclude that percutaneous CT and fluoroscopically guided gastrostomy placement with push-type tubes using an RFB catheter is a safe and effective means of gastric feeding when performed by radiologists.