J Korean Soc Radiol.  2011 Apr;64(4):333-339. 10.3348/jksr.2011.64.4.333.

Treatment of Spinal Osseous Metastasis with Combined Percutaneous Radiofrequency Ablation and Vertebroplasty

• Huh S
• Hong SJ
• Kim JH
• Kim YL
• Bae HJ
• Kang EY

• KMID: 1443536
• DOI: http://doi.org/10.3348/jksr.2011.64.4.333

Abstract

Recent introduction of image-guided percutaneous methods to treat unresectable bone tumors including metastases that do not respond to conventional radiotherapy or chemotherapy has proven to be effective. Here we present three successfully treated cases of metastatic bone lesions: two cases of malignant bone metastases in the lumbar spine and one in the sacral bone, using combined percutaneous radiofrequency ablation and percutaneous vertebroplasty/cementoplasty. A brief review of literature is also included.

MeSH Terms

Bone Cements
Catheter Ablation
Neoplasm Metastasis
Spine
Vertebroplasty
Bone Cements

Figure

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  Fig. 1 RFA and combined percutaneous vertebroplasty of spinal metastasis in a 59-year-old man with hepatocelluar carcinoma. Sagittal T1 (A), T2 (B), and post-contrast fat suppressed T1 (C) - weighted images of the lumbar spine show a round mass lesion in the L3 body with T1 low, T2 heterogeneous high signal intensity, diffuse and prominent peripheral enhancement, representing a metastatic lesion. Axial CT scan during RFA (D) demonstrates the inserted RFA needle with a 3 cm active tip in the center of the lesion through the 11-gauge vertebroplasty cannula. Bone cement is well packed in the center of the metastatic lesion on the immediate prone AP view (E) and sagittal CT scan (F) after combined vertebroplasty.

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  Fig. 2 A 49-year-old man with hepatocelluar carcinoma and lumbar metastasis treated with RFA and combined percutaneous vertebroplasty. Axial T2 (A), T1 (B) - MR images show a heterogeneous T2 high, T1 low signal intensity mass with surrounding bone edema in the right side of the L4 body. Axial CT scan during RFA (C) demonstrates an inserted RFA needle with a 2 cm active tip in the center of the lesion. Immediate prone AP radiograph (D) shows injected cement in the lesion and surrounding bone marrow of the L4 body. Small amount of intradiscal cement leakage is seen (arrow).

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  Fig. 3 Metastatic renal cell carcinoma involving the left sacrum in a 67-year-old man. Axial T1- (A), T2- (B) weighted MR images show an inhomogeneous T1 low, T2 high signal mass in left sacral ala with bone expansion. Axial CT scan during RFA (C) shows the needle inserted in the center of the left sacral lesion. Frontal (D) and lateral (E) radiographs taken after RFA and cementoplasty show well confinement of polymethylmetacrylate within the sacral mass lesion.

Reference

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