CT-guided Percutaneous Radiofrequency Ablation Research Articles

Our Single Center Experience in Osteoid Osteoma Patients Treated with CT-Guided Percutaneous Radiofrequency Ablation Treatment and Follow-up.

Introduction Osteoid osteoma (OO) is a painful benign bone tumor. Typically, it causes pain that is most noticeable during the night, which is improved by nonsteroidal anti-inflammatory drugs. In the treatment of symptomatic lesions, open surgery for nidus removal is the gold standard. However, surgical technical difficulties and morbidities vary by location. Percutaneous radiofrequency ablation (RFA) therapy guided by computed tomography (CT) is now a popular treatment option for OO. This study aims to assess our single-center experience with the technique, complications, and procedure effectiveness. Materials and Methods The study included fifteen patients who were treated between 2017 and 2021. A retrospective analysis was carried out on archive images and file records. The lesions' location, nidus width, and affected area (cortical, medullary) were all recorded. The procedure and technical success, as well as postoperative complications and the need for repeat ablation, were all documented. Results A total of 20 patients, 18 men, and 2 women, were included in the study, and 12 of them were pediatric patients. The patients' mean age was 16.9±7.3 years old, and the mean nidus diameter was 7.1±8.7 mm. There were 13 cortical niduses, 2 intramedullary niduses, and 5 corticomedullary niduses. The lesions were in the femur (n=12), tibia (n=6), scapula (n=1), and vertebrae (n=1). Two recurrences (10%) were observed in our patients during the follow-up. Patient with a femoral OO, the pain started again 12 weeks after the procedure and we performed additional RFA. The patient with vertebral OO had fewer symptoms and full recovery was not achieved. Therefore, the vertebral OO was ablated again 4 months later, and clinical success was achieved. One patient had a minor burn at the entry site that went away on its own after a short period of time. Except for the patient who was scheduled for a repeat RFA, no recurrence has been observed so far. The primary and secondary success rates are, respectively, 90% (18/20) and 100% (20/20). Conclusion RFA has a high success rate in treating OO. The procedure failure and recurrence rates are low. There are possibilities for posttreatment pain relief, early discharge, and a quick return to daily life. For inappropriate lesion localization, the RFA process replaces surgical treatment. The procedure-related complication rate is low. On the other hand, the burn during the procedure can be a serious problem.

Safety and efficacy of CT-guided percutaneous radiofrequency ablation for non-small cell lung cancer: a single-center, single-arm analysis.

Non-small cell lung cancer (NSCLC) is a prevalent malignant tumor, and the commonly treatment modalities include surgery, radiotherapy, chemotherapy, etc. Currently, CT-guided percutaneous radiofrequency ablation (RFA) for the treatment of cancers has been widely performed. This study aimed to evaluate the safety and efficacy of this therapy in NSCLC patients. Thirty-five NSCLC patients were enrolled in this study and all received CT-guided percutaneous RFA therapy. The outcome measures included the changes in forced respiratory volume in the first second (FEV1), total lung volume (TLC), lesion size and computed tomography (CT) values of the region of interest (ROI) before and after treatment. The main efficacy measures comprised complete tumor ablation and local recurrence after initial treatment, as well as the objective response rate (ORR) and disease control rate (DCR) after 6 months of treatment. After receiving CT-guided percutaneous RFA therapy, the target lesion was effectively controlled and CT values gradually decreased. Besides, no significant changes were observed in the patient's lung function, postoperative complications were experienced by a total of 10 patients, primarily including pneumothorax, infection, lung hollowing. Fortunately, all these complications were successfully managed with appropriate treatment. Following the initial RFA treatment, 31 patients (88.57%) achieved complete ablation, while 6 patients experienced local recurrence. After 6 months of treatment, the ORR and DCR were found to be 68.57% and 82.86% respectively. CT-guided percutaneous RFA has demonstrated favorable safety and efficacy in the treatment of patients with NSCLC at different stages, which represented a promising therapeutic modality.

Robot-assisted Percutaneous Radiofrequency Ablation for the Treatment of Osteoid Osteomas.

Percutaneous CT-guided radiofrequency ablation (CT-RFA) is a widely accepted procedure for treatment of osteoid osteomas. However, the application of CT-RFA was restricted as a result of some drawbacks, such as radiation exposure, and inconvenience in general anesthesia. The primary aim of this study is to evaluate the safety and efficacy of intra-operative TiRobot-assisted percutaneous RFA of osteoid osteomas. We retrospectively reviewed 21 medical files of patients who were treated with percutaneous RFA of osteoid osteomas guided by the TiRobot system in our institution between March 2021 and April 2022. The three-dimensional images obtained by a 3D C-arm intra-operatively were sent to the TiRobot system. The puncture point and trajectory were designed. Then the guide pin was positioned to the lesion with the assistance of TiRobot and the biopsy sheath was inserted into the lesion through the guide pin. The tumor was biopsied for pathological examination. Then the RFA needle was inserted into the nidus through the biopsy sheath for thermal ablation. Data were extracted on the associated complications, the reduction in pain at 1 month and 1 year postoperatively assessed by the visual analogue scale (VAS). A paired t-test was used to compare the pre-operative and post-operative VAS scores. The patients included 17 males and four females with a mean age of 19.5 ± 10.4 years (range 3-45 years). Lesions were located on the femur in nine cases, on the tibia in nine cases, on the humerus in one case, on the calcaneus in one case, and on the acetabulum in one case. TiRobot-assisted percutaneous RFA was successfully performed on all 21 patients. There was no intra-operative or post-operative complications observed. Pathological diagnosis of osteoid osteoma was obtained in 11 patients, but the other 10 cases were not pathologically diagnosed. The mean follow-up time was 18.8 months (range: 12-26 months).Post-operative VAS scores were reduced significantly in all cases. The mean VAS score decreased from 6.5 pre-operatively to 0.5 at 1 month post-operatively and to 0.1 at 1 year post-operatively. As a reliable technique for localizing and resection of nidus, TiRobot-assisted percutaneous RFA is a safe and effective option for the treatment of osteoid osteomas.

A comparative study assessing the efficacy and safety of radiofrequency ablation versus surgical treatment for osteoid osteoma: retrospective analysis in a single institution

ObjectiveWe aim to evaluate the efficacy of CT-guided percutaneous radiofrequency ablation (RFA) and surgical treatment in osteoid osteoma (OO) treated at the Medical University of Graz.Materials and methodsIn a single-institution study, we analysed data from January 2005 to January 2021 of patients with histological/radiological diagnosis of OO. CT and MRI scans were reviewed for typical findings. Means (with SD) and medians (with IQR) were reported for normally and non-normally distributed variables. Differences between groups were assessed using chi-squared tests and t-tests.ResultsOne hundred nineteen patients (mean age: 21.6 ± 10.9 years; 63.9% males) with confirmed OO were retrospectively evaluated. 73 and 43 patients underwent RFA and surgery, respectively. In three cases, RFA combined with surgery was performed. Pre-intervention, 103 patients (88.8%) had undergone CT, and 101 had an MRI (87.1%). The nidus was confirmed in 82.5% of cases with CTs (85/103) and 63.4% with MRIs (64/101). The majority of nidi were located cortically (n = 96; 82.8%), most frequently in the femur (38 patients, 33.3%) with a median size of 8.0 mm (IQR: 5.0–12.0 mm). Median symptom duration before treatment was 6.0 (IQR: 4.0–13.0) months. The complication rate was 12.1% (14/116; 15.1% RFA vs. 7.0% surgery; p = 0.196). In total, 11.2% of patients had persistent symptoms after one week with clinical success rates of RFA and surgery, 86.3% and 90.7% (p = 0.647), respectively.ConclusionCompared to surgical treatment, CT-guided percutaneous RFA is a safe, minimally invasive, reliable, and efficient treatment option for OO.Critical relevance statementThis article critically assesses the diagnosis and treatment of osteoid osteoma, emphasising accurate imaging, and detailing a non-invasive option for effective management.Key points• This study analyses 116 cases of OO at one institution, focusing on symptom persistence, recurrence in short-term follow-up, and complications in two study groups.• Surgery showed higher, though not statistically significant, success despite comparable symptom persistence; CT displayed typical OO features more than MRI, regardless of the intramedullary, cortical and subperiosteal location as well as the site of the affected bone.• CT-guided RFA is an effective therapeutic alternative for OO compared to surgical intervention. In case of atypical OO appearance, RFA is not the first-line treatment.Graphical

Comparison of Microwave and Radiofrequency Ablation for the Treatment of Small- and Medium-Sized Hepatocellular Carcinomas in a Prospective Randomized Trial.

To compare the therapeutic response and clinical outcome of CT-guided percutaneous microwave (MWA) and radiofrequency ablation (RFA) for the treatment of small- and medium-sized HCC. In this prospective trial, 50 patients with HCC were randomly assigned to MWA or RFA treatment. MRI was performed 24 h before and after ablation and subsequently in 3-month intervals. Ablation volumes, ablation durations, adverse events (AE), technique efficacy, technical success, local tumor progression (LTP), disease-free survival (DFS), intrahepatic distant recurrence (IDR), and overall survival (OS) rates were evaluated. The mean ablation volume was 66.5 cm³ for MWA and 29.2 cm³ for RFA (p < 0.01). The mean ablation durations for MWA and RFA were 11.2 ± 4.0 min and 16.3 ± 4.7 min, respectively (p < 0.01). Six mild AEs were documented (p > 0.05). All treatments had a technical success rate and a technique efficacy rate of 100 % (50/50, p = 1.00). LTP within 2 years occurred in 1/25 (4 %) in the MWA group and in 4/25 (16 %) in the RFA group (p = 0.06). IDR within 2 years was 8/25 (32 %) for MWA and 14/25 (56 %) for RFA (p < 0.05). The median DFS was 24.5months and 13.4 months for MWA and RFA, respectively (p = 0.02). The 1-, 2-, 3-year OS rates were 100 %, 80 %, 72 % in the MWA group and 72 %, 64 %, 60 % in the RFA group, respectively (p ≥ 0.14). The clinical outcome after MWA or RFA for HCC treatment was very similar with no significant differences in LTP or OS. However, MWA shows a trend toward better DFS with fewer IDRs than RFA. · MWA allows for larger ablation volumes and a shorter treatment duration compared to RFA in patients with HCC.. · MWA shows a trend toward better disease-free survival and fewer intrahepatic distant recurrences compared to RFA.. · The three-year survival rates show no significant difference between the two methods..

Long-term follow-up of CT-guided percutaneous radiofrequency ablation of T1 renal cell carcinoma

BackgroundRadiofrequency ablation (RFA) has an established role in effective treatment of renal cell carcinomas (RCCs), as most of RCCs are diagnosed incidentally in early stages. Long-term follow-up is however important to consolidate the technique. Most of the literature contains series of short-term follow-ups of periods shorter than 2 years. This study in hand demonstrates the results of longer-term follow-up than the previously published series.ResultsData analysis of 31 patient records involved in this study demonstrated the high clinical efficacy of RFA for long term, 12-year follow-up, by following the absence of tumor recurrences, as shown on regular interval contrast enhanced computed tomography (CT) and or magnetic resonance imaging (MRI).ConclusionsRFA continues to prove its competent role in treating RCCs on longer-term follow-ups; the smaller the size of a tumor and the more peripheral the tumor is, the more effective the therapy. Even in larger early stages tumors, repeating the ablative sessions results in complete ablation without the need for more invasive surgical interventions.

Advances in Management of Osteoid Osteoma by Radiofrequency Ablation

Background Osteoid Osteoma is a benign painful skeletal neoplasm which is usually smaller than 1.5 cm. Surgery has been considered its standard treatment, currently, Percutaneous CT-guided Radiofrequency Ablation is proved to be the treatment of choice in such cases. Objective To evaluate the effectiveness of CT-guided radiofrequency ablation for the treatment of spinal and non-spinal osteoid osteomas, technical requirements needed for safe radiofrequency ablation and recent advances in this respect. Patients and Methods This study is a retrospective study conducted on patients with osteoid osteoma who underwent Radiofrequency ablation from January 2019 till July 2020 at Ain Shams University Hospitals, Maadi Military Hospital and El Galaa Military Hospital, followed by postprocedure computed tomography (CT) follow up. Results Location, calcification of the nidus, coagulation time, lesion size, and previous treatment are dependent risk factors compared regarding outcome. Conclusion We concluded that CT-guided RFA is a feasible, safe, and effective treatment for spinal and extra-spinal osteoid osteoma and is easily repeatable after unsuccessful treatment. Surgery should be reserved for lesions causing nerve root compression in spinal lesions.

Outcomes of Osteoid Osteoma Treated by Percutaneous CT-Guided Radiofrequency Ablation.

Introduction Osteoid osteomas are the most frequent true benign bone tumor in the adolescent age group and the third most prevalent benign bone tumor overall. This study was designed to assess the effectiveness of the procedure and correlate it with the analgesia offered because of the significant burden of this illness and new literature supporting the successful outcomes of image-guided percutaneous radiofrequency ablation (RFA) in osteoid osteoma. Methodology This hospital-based interventional trial was carried out in a tertiary care referral center. Forty-two patients with osteoid osteoma, ranging in age from 9 to 30, were included in the study. The patients received RFA guided by computed tomography (CT), and they were postoperatively monitored at one, two, and four weeks and three, six months, and 12 months. A numerical pain scale (NPS) was used to evaluate the patient's pain both before and after the procedure. The preoperative and postoperative results were contrasted. Results A total of 42 participants were enrolled in the study. Eight (19.05%) women and 34 (80.95%) men made up the group. Complete pain alleviation (NPS=0) was attained in 42.8% and 96.4% of the study groupinthe first and second weeks post-procedure. Almost all patients began protected weight-bearing at one week, according to their level of pain tolerance. Osteoid osteoma of the talus was a remnant lesion in one patient that required further treatment after two weeks. During the duration of the follow-up, no problems were recorded. Conclusion Percutaneous CT-guided RFA of osteoid osteoma is a safe, minimally invasive procedure and greatly reduces the duration of hospitalization. It has excellent functional outcomes and no known complications.

CT-guided radiofrequency ablation of the extracranial cranial nerve for the treatment of Meige's syndrome.

BackgroundMeige’ s syndrome, a rare form of dystonia, lacks effective treatment. The purpose of this study was to determine the effects of CT-guided percutaneous extracranial radiofrequency ablation of the facial and/or trigeminal nerves in the treatment of Meige’s syndrome.MethodsA total of 10 patients were enrolled in this study, with the numbers of blepharospasm dystonia syndrome (BDS), oromandibular dystonia syndrome (ODS), and blepharospasm combined with oromandibular dystonia syndrome (B-ODS) being 7, 1, and 2, respectively. BDS patients underwent radiofrequency ablation of the bilateral stylomastoid foramen facial nerve; ODS patients underwent radiofrequency ablation of the bilateral foramen oval trigeminal mandibular branch, and B-ODS patients underwent radiofrequency ablation of the bilateral stylomastoid foramen facial nerve and foramen oval trigeminal mandibular branch. The therapeutic effects and complications were observed.ResultsAll 10 patients in this series experienced improved Meige’s syndrome-related symptoms after extracranial radiofrequency ablation of the cranial and/or mandibular branches of the extracranial trigeminal nerve. Adverse events included class II–III facial paralysis and/or mandibular skin numbness. Two patients had recurrences at the 18th and 22nd months postoperatively, respectively; the other patients were being followed up.ConclusionThese results shown that CT-guided radiofrequency ablation of bilateral stylomastoid foramen facial nerve and/or oval foramen trigeminal mandibular branch can effectively treat the corresponding types of Meige’s syndrome. According to preliminary observations, the therapeutic effect may last more than 18 months.

Role of percutaneous CT-guided radiofrequency ablation in treatment of intra-articular, in close contact with cartilage and extra-articular osteoid osteomas: comparative analysis and new classification system.

We investigated procedural safety, technical and clinical outcomes of the percutaneous image-guided radiofrequency ablation (PRFA) of intra-articular (IA), intra-articular close to cartilage (IACC), and extra-articular (EA) osteoid osteomas (OO). We proposed a new radiologic classification for osteoid osteoma depending on the degree and location of sclerosis which may correlate with technical failure and/or difficulties. According to the inclusion criteria, we enrolled consecutive patients who were referred to the investigation center from June 2018 to January 2022. After clinical and CT imaging features were suggestive for the diagnosis of OO, all the patients were treated by percutaneous CT-guided RFA with a standardized technique. Biopsy of the lesion was not performed in all patients. A retrospective analysis was conducted to assess the procedure's technical, primary clinical, and secondary clinical successes, recurrence rate, and complications. We classified all the OOs according to a new proposed classification of the site and the amount of sclerosis. A total number of 55 patients were enrolled in our study according to the inclusion criteria. The mean age of the enrolled patients was 24.07 ± 14.71years (ranges from 7 to 57years). The M/F ratio was roughly 2:1. The mean follow-up was 20.18 ± 12.60months (ranges from 2 to 44months). EA group included 36 patients, IA included 5 and IACC included 14 patients. Technical success was achieved in all cases of IA and IACC groups. Technical success in the EA group was 97.22% (1 technical failure). Primary clinical success was 100%, 92.85%, and 91.66% for IA, IACC, and EA groups, respectively. Accordingly, the recurrence rate was 5.88% in EA, and 7.14% in IACC, while no recurrence occurred in the IA group. No complications occurred. The secondary success rate of the 3 cases of recurrence was 100%. PRFA proved to be a safe procedure with a high rate of success for OO treatment even in intra-articular lesions in close contact with cartilage. This study showed that the results in terms of technical and clinical success are comparable for IA OO, IACC OO, and EA OO, even if the recurrence rate was higher in EA OO. Our proposed new classification of the degree and location of sclerosis may correlate to technical failure, but further studies with a larger number of patients are needed for validation.

Osteoid Osteoma of Scaphoid Treated with Radiofrequency Ablation

Osteoid osteoma is one of the commonest benign bone tumour of adolescence. Diagnosis is based upon the typical clinical features, site of occurrence and imaging findings. Occurrence of this lesion in an atypical site is associated with delay in diagnosis and challenges in management. We present a rare case of osteoid osteoma in scaphoid in a 14-year-old girl. Comprehensive work-up using radiograph, computerized tomography (CT), magnetic resonance imaging and Tc99-multidetector methylene diphosphonate (MDP) bone scan was used to make the correct diagnosis over other conditions with similar presentation like de Quervain tenosynovitis, intersection syndrome and inflammatory arthropathies. We also describe the treatment using CT-guided percutaneous radiofrequency ablation of this lesion and a brief literature review regarding the incidence of this lesion and treatment options available. Level of Evidence: Level V (Therapeutic).

Efficacy and Safety of Combined Embolization and Radiofrequency Ablation in Stage 1 Renal Cell Carcinomas.

To retrospectively evaluate outcomes of a combined interventional approach to stage 1 (cT1cN0cM0) renal cell carcinomas (RCCs) by transarterial embolization (TAE) followed by percutaneous CT-guided radiofrequency ablation (RFA) in patients ineligible for surgery. 13 patients (9 male, 4 female, 69.6 ± 16.6 y/o) with 14 RCCs (largest diameter: 40.4 ± 6.7 mm, cT1a: 4, cT1b: 10) were treated by RFA a median of one day after TAE in a single center. Indications for minimally invasive interventional therapy were bilateral RCCs (n = 4), RCCs in a single kidney after nephrectomy (n = 3), increased surgical risk due to comorbidities (n = 4), and rejection of surgical therapy (n = 2). Technical success, effectiveness, safety, ablative margin, cancer-specific survival, overall survival, and tumor characteristics were analyzed. All RCCs were successfully ablated after embolization with a minimum ablative margin of 1.2 mm. The median follow-up was 27 (1-83) months. There was no residual or recurrent tumor in the ablation zone. No patient developed metastasis. Two minor and two major complications occurred. Four patients with severe comorbidities died during follow-up due to causes unrelated to therapy. The 1-year and 5-year overall survival was 74.1 % each. Cancer-specific survival was 100 % after 1 and 5 years. There was no significant decline in mean eGFR directly after therapy (p = 0.226). However, the mean eGFR declined from 62.2 ± 22.0 to 50.0 ± 27.8 ml/min during follow-up (p < 0.05). The combination of TAE and RFA provides an effective minimally invasive therapy to stage 1 RCCs in patients ineligible for surgery. The outcomes compare favorably with data from surgery. · Interventional treatment by TAE and ablation is a safe and effective alternative to surgery in stage 1 RCCs.. · Focal therapy of RCCs preserves renal function.. · A small ablative margin appears to be sufficient in the ablation of RCCs.. · Wessendorf J, König AM, Heers H et al. Efficacy and Safety of Combined Embolization and Radiofrequency Ablation in Stage 1 Renal Cell Carcinomas. Fortschr Röntgenstr 2022; 194: 1020 - 1025.

Observation of the Curative Effect of Acupuncture for Tonifying Kidney and Removing Blood Stasis Combined with Radiofrequency Surgery in Patients with NSCLC and the Diagnostic Efficacy of Combined Detection of NTx, BGP, and CYFRA21-1 in the Occurrence of Bone Metastases.

The curative effect observation of acupuncture for tonifying kidney and removing blood stasis combined with radiofrequency surgery in patients with non-small-cell lung carcinoma (NSCLC) and the diagnostic efficacy of combined detection of NTx, BGP, and CYFRA21-1 for bone metastases are investigated. 122 NSCLC patients admitted to our hospital from January 2019 to December 2021 are selected for the examination, and the two sets of patients are randomly divided into the study set and the control set using the random number table method, with 61 cases in each set. Patients in the control set are given CT-guided percutaneous radiofrequency ablation therapy, and patients in the study set are given a combination of acupuncture therapy for tonifying the kidney and removing blood stasis on the basis of the therapy of the control set. The experimental results show that for NSCLC patients, the application of kidney-tonifying and stasis-removing acupuncture therapy combined with radiofrequency surgery can notoriously enhance the clinical therapy effect and enhance the quality of life of patients, and the detection of NTx, BGP, and CYFRA21-1 indicators can effectively predict the prognosis.

Systematic Review of Outcomes after Radiofrequency Ablation for Fibroids: An Aagl Practice Committee Evidence Review

Study Objective To review the existing literature regarding short- and long-term outcomes after radiofrequency (RF) fibroid ablation. Design Systematic review. Setting N/A. Patients or Participants All studies that are comparative were included, and non-comparative studies with at least 10 participants per group, in any language, in any country/setting were included. Interventions We conducted a systematic review or all studies examining the use of RF ablation for the treatment of fibroids which reported clinical and patient-centered outcomes and complications. We searched existing systematic reviews and Medline, Embase, and Cochrane from inception through February 2, 2021. We included comparative and noncomparative studies of RF ablation and RF ablation compared to other interventions. Measurements and Main Results 7260 abstracts were doubly reviewed by members of the AAGL Practice Committee. Of these, 29 studies met inclusion criteria. 11 studies examined laparoscopic ultrasound guided RF ablation. 2 studies examined laparoscopic RF ablation (without imaging guidance). 5 studies examined percutaneous ultrasound guided RF ablation, 1 study examined percutaneous CT guided RF ablation, 6 studies examined transvaginal ultrasound guided RF ablation. 4 studies examined transcervical ultrasound guided RF ablation. Conclusion Worldwide, various types of radiofrequency fibroid ablation procedures are being performed for the treatment of symptomatic fibroids, including laparoscopic, percutaneous, transcervical and transvaginal routes, either with or without image guidance. Review of the available literature demonstrates that these procedures are associated with rare major complications and reintervention rates are low. Fibroid volume, bleeding, pain, bulk symptoms and overall quality of life improve after RF ablation. To review the existing literature regarding short- and long-term outcomes after radiofrequency (RF) fibroid ablation. Systematic review. N/A. All studies that are comparative were included, and non-comparative studies with at least 10 participants per group, in any language, in any country/setting were included. We conducted a systematic review or all studies examining the use of RF ablation for the treatment of fibroids which reported clinical and patient-centered outcomes and complications. We searched existing systematic reviews and Medline, Embase, and Cochrane from inception through February 2, 2021. We included comparative and noncomparative studies of RF ablation and RF ablation compared to other interventions. 7260 abstracts were doubly reviewed by members of the AAGL Practice Committee. Of these, 29 studies met inclusion criteria. 11 studies examined laparoscopic ultrasound guided RF ablation. 2 studies examined laparoscopic RF ablation (without imaging guidance). 5 studies examined percutaneous ultrasound guided RF ablation, 1 study examined percutaneous CT guided RF ablation, 6 studies examined transvaginal ultrasound guided RF ablation. 4 studies examined transcervical ultrasound guided RF ablation. Worldwide, various types of radiofrequency fibroid ablation procedures are being performed for the treatment of symptomatic fibroids, including laparoscopic, percutaneous, transcervical and transvaginal routes, either with or without image guidance. Review of the available literature demonstrates that these procedures are associated with rare major complications and reintervention rates are low. Fibroid volume, bleeding, pain, bulk symptoms and overall quality of life improve after RF ablation.

CT-guided percutaneous radiofrequency ablation for hepatic carcinoma

CT-guided percutaneous radiofrequency ablation for hepatic carcinoma

Computed tomography guided radiofrequency ablation of osteoid osteoma in children: a single center's experience.

To report a single center's experience evaluating the efficacy and safety of computed tomography-guided radiofrequency ablation for the treatment of osteoid osteoma in children. Institutional database research identified 33 symptomatic patients (≤ 18years of age; male/female ratio: 21/12, mean age 13.09 ± 3.66) with osteoid osteoma who were treated by CT-guided RFA. Technical and clinical success as well as complication rates were recorded. The duration of the procedure, the number of computed tomography scans and the results of the biopsy were assessed. Pain, prior, the following morning and 1week, 1/6/12months after the procedure were compared by means of a numeric visual scale (NVS) questionnaire. Mean lesion size was 8.28 ± 4.24mm. Mean follow-up was 23.33 ± 17.61months (range 12-62). Mean pain score prior to radiofrequency ablation was 9.06 ± 0.80 NVS units. On week 1 and 1/6/12months, all patients were pain-free reporting 0 NVS units (p < 0.05). The mean procedure time was 54min (range 51-59) and a mean of 7 CT scans were performed during the ablation session. RF electrode was successfully placed in the center of the nidus in all cases. In our study, none of our patient experienced recurrence of the pain, nor complications. The present study demonstrates that percutaneous CT-guided radiofrequency ablation constitutes a safe and effective technique for osteoid osteoma treatment in children.

Software-based planning of ultrasound and CT-guided percutaneous radiofrequency ablation in hepatic tumors

ObjectivesRadiofrequency ablation (RFA) can be associated with local recurrences in the treatment of liver tumors. Data obtained at our center for an earlier multinational multicenter trial regarding an in-house developed simulation software were re-evaluated in order to analyze whether the software was able to predict local recurrences.MethodsTwenty-seven RFA ablations for either primary or secondary hepatic tumors were included. Colorectal liver metastases were shown in 14 patients and hepatocellular carcinoma in 13 patients. Overlap of the simulated volume and the tumor volume was automatically generated and defined as positive predictive value (PPV) and additionally visually assessed. Local recurrence during follow-up was defined as gold standard. Sensitivity and specificity were calculated using the visual assessment and gold standard.ResultsMean tumor size was 18 mm (95% CI 15–21 mm). Local recurrence occurred in 5 patients. The PPV of the simulation showed a mean of 0.89 (0.84–0.93 95% CI). After visual assessment, 9 incomplete ablations were observed, of which 4 true positives and 5 false positives for the detection of an incomplete ablation. The sensitivity and specificity were, respectively, 80% and 77% with a correct prediction in 78% of cases. No significant correlation was found between size of the tumor and PPV (Pearson Correlation 0.10; p = 0.62) or between PPV and recurrence rates (Pearson Correlation 0.28; p = 0.16).ConclusionsThe simulation software shows promise in estimating the completeness of liver RFA treatment and predicting local recurrence rates, but could not be performed real-time. Future improvements in the field of registration could improve results and provide a possibility for real-time implementation.

Awake CT-guided percutaneous stylomastoid foramen puncture and radiofrequency ablation of facial nerve for treatment of hemifacial spasm.

Hemifacial spasm (HFS) is a debilitating neuromuscular disorder with limited treatment options. The current study describes a novel minimally invasive procedure that provided effective and sustained relief for patients with HFS. The authors provide a detailed description of the awake CT-guided percutaneous radiofrequency ablation (RFA) of the facial nerve for treatment of HFS, and they examine its clinical efficacy. This is the first time in the literature that this procedure has been applied and systematically analyzed for HFS. Patients with a history of HFS were recruited between August 2018 and April 2020. Those with a history of cerebellopontine lesions, coagulopathy, ongoing pregnancy, cardiac pacemaker or defibrillator implants, or who declined the procedure were excluded from the study. Fifty-three patients who met the study criteria were included and underwent awake CT-guided RFA. Under minimal sedation, a radiofrequency (RF) needle was used to reach the stylomastoid foramen on the affected side under CT guidance, and the facial nerve was localized using a low-frequency stimulation current. Patients were instructed to engage facial muscles as a proxy for motor monitoring during RFA. Ablation stopped when the patients' hemifacial contracture resolved. Patients were kept for inpatient monitoring for 24 hours postoperatively and were followed up monthly to monitor resolution of HFS and complications for up to 19 months. The average duration of the procedure was 32-34 minutes. Postoperatively, 91% of the patients (48/53) had complete resolution of HFS, whereas the remaining individuals had partial resolution. A total of 48 patients reported mild to moderate facial paralysis immediately post-RFA, but most resolved within 1 month. No other significant complication was observed during the study period. By the end of the study period, 5 patients had recurrence of mild HFS symptoms, whereas only 2 patients reported dissatisfaction with the treatment results. The authors report for the first time that awake CT-guided RFA of the facial nerve at the stylomastoid foramen is a minimally invasive procedure and can be an effective treatment option for HFS.

Feasibility and safety of percutaneous computed tomography guided radiofrequency ablation of lymph nodes in oligometastatic patients: a single center's experience.

To retrospectively evaluate feasibility and safety of CT-guided percutaneous radiofrequency ablation (RFA) of metastatic lymph nodes (LN) in terms of achieving local tumor control. Institutional database research identified 16 patients with 24 metastatic LNs who underwent percutaneous CT-guided radiofrequency ablation. Mean patient age was 66.6 ± 15.70 years (range 40-87) and male/female ratio was 8/8. Contrast-enhanced CT or MRI was used for post-ablation follow-up. Patient and tumor characteristics and RFA technique were evaluated. Technical and clinical success on per tumor and per patient basis as well as complication rates were recorded. Mean size of the treated nodes was 1.78 ± 0.83 cm. The mean number of tumors per patient was 1.5 ± 0.63. The mean procedure time was 56.29 ± 24.27 min including local anesthesia, electrode(s) placement, ablation and post-procedural CT evaluation. Median length of hospital stay was 1.13 ± 0.34 days. On a per lesion basis, the overall complete response post-ablation according to the mRECIST criteria applied was 75% (18/24) of evaluable tumors. Repeat treatment of an index tumor was performed on two patients (three lesions) with complete response achieved in 87.5% (21/24) of evaluable tumors following a second RFA. On a per patient basis, disease progression was noted in 10/16 patients at a mean of 13.9 ± 6.03 months post the ablation procedure. CT-guided percutaneous RFA for oligometastatic LNs is a safe and feasible therapy. With this percutaneous therapeutic option, metastatic LNs can be eradicated with a very low complication rate.

Safety and oncological outcome following radiofrequency ablation of small renal masses in a single center

Objective To evaluate the safety and efficacy of percutaneous CT-guided radiofrequency ablation (RFA) for small renal masses (SRMs) at a large single-institution center during a period of 12 years. Materials and methods A total of 118 patients underwent RFA for SRM between July 2006 and July 2018 at our institution. We included demographic information, comorbidity, procedural details, and oncological outcome in the analysis. Survival analysis was performed using competing risk. Results 87 males and 31 females with median age 66 years underwent RFA. Median tumor size was 23 mm. Tumor biopsy was performed in 94% of cases, of which 56% were confirmed renal cell carcinoma (RCCs). Twenty-eight patients had benign tumors or underwent treatment for recurrence of prior RCC. Median follow-up of 5 years. Median Charlson Comorbidity Index was 5. Major complications occurred in 1.7%. No change in kidney function was observed. The initial treatment response was 98%. Among patients treated for newly diagnosed radiological suspected RCC without Von Hippel-Lindau or benign biopsy (90 pts), the cumulative incidence of radiological recurrence after 5 and 10 years was 6.6% (95% CI: 0.8–12%) and 16% (95% CI: 4.2–28%), respectively. Three patients died of RCC during follow-up. The cumulative incidence of kidney cancer death was 4.5% (95% CI: 4.3–13%) after 10 years. The incidence of other-cause mortality was 50% (95% CI: 34–67%). Conclusion CT-guided RFA is a safe and effective treatment option for patients unsuitable for surgery. RFA is a good alternative to partial or radical nephrectomy for SRMs, although randomized trials comparing surgery to minimally invasive thermal ablation techniques are missing.