Techniques in vascular and interventional radiology
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Tech Vasc Interv Radiol · Mar 2009
ReviewEpidural steroid injections and selective nerve root blocks.
Epidural steroid injections and lumbar nerve root block/steroid injection are commonly performed interventional treatments for spine-related pain. These procedures are the foundation of any image-guided spine pain management practice. While more generic and not target-specific, epidural steroid injections are highly effective in a large proportion of patients, including patients with axial pain (neck or low back pain), radiculopathy, or spinal stenosis with neurogenic claudication. ⋯ Fluoroscopy can be the routine approach to all injections. Computed tomography or computed tomographic fluoroscopy can be used as the primary approach in lumbar epidural or nerve root injections or be used as an alternative technique in unique cases. While the basic technical approach to epidural steroid administration in the cervical, thoracic, and lumbar regions is similar, each region has unique issues that must be addressed.
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Chronic back pain and other refractory pain syndromes are a documented burden on our society. They also are a huge cost in quality of life and dollars spent on health care. ⋯ We describe in this article the basic techniques and methods of both the stimulation trial and the permanent implantation of the leads and generator. With advanced imaging and the minimally invasive approach we further explain how to minimize any risk associated with this percutaneous procedure.
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The development of image-guided percutaneous techniques for local tumor ablation has been one of the major advances in the treatment of liver malignancies. Over the past two decades, several methods for chemical or thermal tumor destruction have been clinically tested. Among these methods, radiofrequency (RF) ablation is currently established as the primary ablative modality at most institutions. ⋯ In addition, RF ablation is emerging as a viable alternative to surgery for inoperable patients with limited hepatic metastatic disease, especially from colorectal cancer. Several series have shown that RF ablation can result in complete tumor eradication in properly selected candidates, and have provided indirect evidence that the treatment improves survival. In this article, we review technique, indications, and clinical results of percutaneous RF ablation in the treatment of HCC and colorectal hepatic metastases.
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Tech Vasc Interv Radiol · Sep 2006
ReviewAssessment of tumor response on MR imaging after locoregional therapy.
Assessment of tumor response after locoregional therapies is important in determining treatment success and in guiding future therapy. Magnetic resonance imaging plays an important role in evaluating treatment response to new therapies directed toward hepatic lesion treatment. The traditional and accepted criteria to determine tumor response in oncology, namely the Response Evaluation Criteria in Solid Tumors (RECIST) and the European Association for the Study of the Liver (EASL) criteria, use decrease in tumor size and lesion enhancement as an indicator of successful therapy. ⋯ In this article we discuss the role of MR imaging in assessing treatment response after various locoregional therapies. We describe the role of tumor size and lesion enhancement as well as ADC mapping. We also discuss the magnetic resonance imaging findings after radiofrequency ablation (RFA), transarterial chemoembolization (TACE) and radioembolization.
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Tech Vasc Interv Radiol · Jun 2006
Conscious sedation for interventional procedures: a practical guide.
Sedation is often used in interventional procedures to minimize discomfort, improve the patient's experience, and reduce the risk of procedural complications by assuring nonmobility and compliance of the patient. Sedation, however, adds a new dimension to the procedure by compromising the patients' normal protective mechanisms and carries the potential of cardiac, respiratory, and cognitive complications. Interventional procedures could be performed under local anesthesia with or without sedation, or under general anesthesia. ⋯ The choice generally depends on patient factors such as age, cardiovascular stability, pain tolerance, and procedural factors such as complexity, extent, and degree of induced pain. In longer and more extensive procedures on more fragile patients, the assistance of an anesthesiologist will be required. The purpose of this article is to provide a basic understanding and a practical guideline for minimal and moderate sedation for the interventionalist contemplating to administer sedation for less involved procedures.