Learning objectives
Describe the image guided interventional procedures in the management of orthopedic oncological cases
To assess the role of each procedure in management of benign and malignant tumours
To familiarize with the indications and techniques of each procedure
Illustrate the adjuvant role of interventional radiology in orthopedic oncology
Background
Management of orthopedic oncology cases are complex necessitating a multidisciplinary approach.
Interventional radiology is emerging as an adjuvant tool to orthopedic oncology forming an important part of the integrated team.
Image guided interventional procedures in orthopedic oncology includes:
Biopsies
Tumour ablation
Trans arterial embolization - pre-operative,
palliative or curative
Intra-arterial chemotherapy
Cementoplasty
Injections: joints,
tendons ,
bursa etc
Nerve blocks
Aspirations and drainages
Image guided Biopsies [1,2] :
Percutaneous biopsy is less invasive,
requires smaller dose of anaesthetics and analgesics,
causes minimal bleeding and biopsy...
Findings and procedure details
Image guided Biopsies [1,2]:
Image-guided MSK biopsies are safe,
minimally invasive,
and effective procedures with high diagnostic accuracy,
lower risk,
better recovery ,
lower patient morbidity,
lower cost compared with open biopsies.
Technique:
Generally,
an 11-15G Trephine Bone Biopsy Needle is used to target bone lesions without significant soft tissue component.
In a circumscribed lytic lesion,
it is prudent to use an 11/13G bone biopsy needle as an anchor.
Through this,
the 18G biopsy needle is passed to obtain soft tissue cores.
Biopsy trajectory should...
Conclusion
Image-guided biopsies are safe,
minimally invasive,
and effective procedures with high diagnostic accuracy,
lower risk,
better recovery,
lower patient morbidity,
lower cost compared with open biopsies.
Percutaneous ablation maybe curative in some benign bone conditions ,
result in significant palliation of pain or other tumor-related symptoms,
prevention of morbidity from skeletally related events,
including fracture or neurologic compromise,
and durable local tumor control.
Pre -operative embolization provides numerous advantages including shrinkage of tumour volume and bloodless surgical field allowing safe resections,
reduction of perioperative hemorrhagic...
References
Le Et Al. Image-Guided Musculoskeletal Biopsies .
Semin Intervent Radiol 2010;27:191–198
Himanshu Pendse ,
Aniruddha Kulkarni,
Manish Agarwal.
Role of Image Guided Interventions in Orthopaedic Oncology.
Journal of Bone and Soft Tissue Tumors 2015 Sep-Dec;1(2):25-29
Motamedi et al.Image-Guided Treatments of Musculoskeletal Tumors.
AJR 2016; 207:517–525
A.
Nicholas Kurup1 Jonathan M.
Morris Matthew R.
Callstrom.
Ablation of Musculoskeletal Metastases.
AJR 2017; 209:713–721
Richard J.T.
Owen.
Embolization of Musculoskeletal Bone Tumors.
Semin Intervent Radiol 2010;27:111–123.
Onder Ofluoglu et al.
Diagnosis and Planning in the Management of Musculoskeletal...