Vertebral augmentation has been used to treat painful vertebral compression fractures and metasta... more Vertebral augmentation has been used to treat painful vertebral compression fractures and metastatic lesions in millions of patients around the world. An international group of subject matter experts have considered the evidence, including but not limited to mortality. These considerations led them to ask whether it is appropriate to allow the subjective measure of pain to so dominate the clinical decision of whether to proceed with augmentation. The discussions that ensued are related below.
Purpose: The purpose of this study is to evaluate the efficacy and safety of Computed Tomography ... more Purpose: The purpose of this study is to evaluate the efficacy and safety of Computed Tomography (CT)-guided mediastinal biopsy. Material and Methods: This is a single centered retrospective study including 32 mediastinal biopsies performed during the last 24 months in a cohort of 29 patients (15 male-14 female, average age 57 years, lesions diameter ranging between 2-12 cm); 3 patients underwent a second biopsy due to insufficient sample post the first attempt . All percutaneous biopsies were performed under local anaesthesia and CT guidance; in all cases an 18G semi-automatic soft tissue biopsy needle was used for tissue sampling. CT scan was used for evaluation of potential complications. Results: The histological outcome was conclusive for 26/29 patients (89.6%), whilst post the second attempt efficacy rate increased to 93.7% (27/29 patients - 30/32 biopsies). Biopsy reports included lymphoma (14 cases), bronchogenic carcinoma (10 cases), metastasis (1 case) and benign substra...
Poster: "ECR 2015 / C-1461 / Imaging of low back pain: Anatomy, imaging modalities, patholog... more Poster: "ECR 2015 / C-1461 / Imaging of low back pain: Anatomy, imaging modalities, pathology and percutaneous treatments" by: "D. K. Filippiadis1, A. Mazioti2, E. Alexopoulou1, K. Malagari3, E. Brountzos4, N. L. Kelekis1, A. D. Kelekis1; 1Athens/GR, 2Pefki - Athens/GR, 3Papagou/GR, 4Haidari/GR"
European Journal of Orthopaedic Surgery & Traumatology, 2021
The purpose of this review is to become familiar with the most common indications for imaging gui... more The purpose of this review is to become familiar with the most common indications for imaging guided percutaneous bipolar radiofrequency ablation, to learn about different technical considerations during performance providing the current evidence. Controversies concerning products will be addressed. We performed a literature review excluding non-English studies and case reports. All references of the obtained articles were also evaluated for any additional information. RFA achieves cytotoxicity by raising target area temperatures above 60 °C, and may be used to achieve total necrosis of lesions smaller than 3 cm in diameter, to debulk and reduce the pain associated with larger lesions, to prevent pathological fractures due to progressive osteolysis or for cavity creation aiming for targeted cement delivery in case of posterior vertebral wall breaching. Protective ancillary techniques should be used in order to increase safety and augment efficacy of RFA in the spine. Percutaneous radiofrequency ablation of vertebral lesions is a reproducible, successful and safe procedure. Ablation should be combined with vertebral augmentation in all cases. In order to optimize maximum efficacy a patient- and a lesion-tailored approach should both be offered focusing upon clinical and performance status along with life expectancy of the patient as well as upon lesion characteristics.
Journal of Vascular and Interventional Radiology, 2021
PURPOSE To assess safety and efficacy of CT-guided radio frequency ablation (RFA) and Magnetic Re... more PURPOSE To assess safety and efficacy of CT-guided radio frequency ablation (RFA) and Magnetic Resonance guided Focused Ultrasounds (MRgFUS) in the treatment of osteoid osteoma with a long-term follow-up study (mean follow-up time longer than 2 years). MATERIALS AND METHODS Database research was carried out in two different centres with experience in musculoskeletal interventions. Both centres, one performing RFA, the other MRgFUS, identified 116 patients, who were submitted to either RFA or MRgFUS for the treatment of symptomatic osteoid osteoma and retrospectively evaluated data regarding pain scores (using a visual analogue scale). Complications were recorded according to the CIRSE classification system. Propensity score matching for multiple variables was performed. Pre- and post-therapy pain scores were compared. RESULTS Out of the 116 patients treated, 61 underwent RFA and 55 MRgFUS. The mean values of pre-treatment pain in the two groups were 9.1±0.88 (RFA) and 8.7±0.73 (MRgFUS) VAS units. Post- treatment statistically significant (p<0.00001) overall reduction in pain symptomatology was recorded. No statistically significant difference was observed between the post-treatment mean values of both groups (p=0.256). Four cases of relapse (1 RFA; 3 MRgFUS) and one complication (RFA) were observed. The analysis from propensity score matching that identified a matched cohort of 48 patients showed similar results. CONCLUSIONS Both techniques for the treatment of osteoid osteoma seem to ensure a similar pain relief. The presence of thick cortical bone over the nidus can of reduce the effectiveness of MRgFUS.
Percutaneous, image-guided musculoskeletal biopsy, due to its minimal invasive nature, when compa... more Percutaneous, image-guided musculoskeletal biopsy, due to its minimal invasive nature, when compared with open surgical biopsy, is a safe and effective technique which is widely used in many institutions as the primary method to acquire tissue and bone samples. Indications include histopathologic and molecular assessment of a musculoskeletal lesion, exclusion of malignancy in a bone/vertebral fracture, examination of bone marrow, and infection investigation. Preprocedural workup should include both imaging (for lesion assessment and staging) and laboratory (including coagulation tests and platelet count) studies. In selected cases, antibiotic prophylaxis should be administered before the biopsy. Core needle biopsy of musculoskeletal lesions has a diagnostic accuracy that ranges from 66 to 98% with higher diagnostic yield for lytic, large-size, malignant lesions and when multiple and long specimens are obtained. Reported complication rates range between 0 and 10% and usually do not e...
To evaluate clinical efficacy/safety of augmented peripheral osteoplasty in oncologic patients wi... more To evaluate clinical efficacy/safety of augmented peripheral osteoplasty in oncologic patients with long-term follow-up. Percutaneous augmented peripheral osteoplasty was performed in 12 patients suffering from symptomatic lesions of long bones. Under extensive local sterility measures, anesthesiology care, and fluoroscopic guidance, direct access to lesion was obtained and coaxially a metallic mesh consisting of 25-50 medical grade stainless steel micro-needles (22 G, 2-6 cm length) was inserted. PMMA for vertebroplasty was finally injected under fluoroscopic control. CT assessed implant position 24-h post-treatment. Clinical evaluation included immediate and delayed follow-up studies of patient&amp;amp;amp;amp;amp;amp;amp;amp;#39;s general condition, NVS pain score, and neurological status. Imaging assessed implant&amp;amp;amp;amp;amp;amp;amp;amp;#39;s long-term stability. Mean follow-up was 16.17 ± 10.93 months (range 2-36 months). Comparing patients&amp;amp;amp;amp;amp;amp;amp;amp;#39; scores prior (8.33 ± 1.67 NVS units) and post (1.42 ± 1.62 NVS units) augmented peripheral osteoplasty, there was a mean decrease of 6.92 ± 1.51 NVS units. Overall mobility improved in 12/12 patients. No complication was observed. Percutaneous augmented peripheral osteoplasty (rebar concept) for symptomatic malignant lesions in long bones seems to be a possible new technique for bone stabilization. This combination seems to provide necessary stability against shearing forces applied in long bones during weight bearing.
Sarcomas are heterogenous mesenchymal neoplasms with more than 80 different histologic subtypes. ... more Sarcomas are heterogenous mesenchymal neoplasms with more than 80 different histologic subtypes. Lung followed by liver and bone are the most common sites of sarcoma metastatic disease. Ablative techniques have been recently added as an additional alternative curative or palliative therapeutic tool in sarcoma metastatic disease. When compared to surgery, ablative techniques are less invasive therapies which can be performed even in non-surgical candidates and are related to decreased recovery time as well as preservation of the treated organ’s long-term function. Literature data upon ablative techniques for sarcoma metastatic disease are quite heterogeneous and variable regarding the size and the number of the treated lesions and the different histologic subtypes of the original soft tissue or bone sarcoma. The present study focuses upon the current role of minimal invasive thermal ablative techniques for the management of metastatic sarcoma disease. The purpose of this review is to...
Transforaminal infiltrations in the cervical spine are governed by a higher rate of vascular punc... more Transforaminal infiltrations in the cervical spine are governed by a higher rate of vascular puncture than in the lumbar spine. The purpose of our study is to assess the safety and efficacy of percutaneous, fluoroscopically guided nerve root infiltrations in cases of cervical radiculopathy. An indirect postero-lateral approach was performed through the ipsilateral facet joint. During the last 2 years, 25 patients experiencing cervical radiculopathy underwent percutaneous, fluoroscopically guided nerve root infiltrations by means of an indirect postero-lateral approach through the ipsilateral facet joint. The intra-articular position of the needle (22-gauge spinal needle) was fluoroscopically verified after injection of a small amount of contrast medium which also verified dispersion of the contrast medium periradicularly and in the epidural space. Then a mixture of long-acting glucocorticosteroid diluted in normal saline (1.5/1 mL) was injected intra-articularly. A questionnaire wit...
Approximately 50% of colorectal cancer patients will develop metastases during the course of the ... more Approximately 50% of colorectal cancer patients will develop metastases during the course of the disease. Local or locoregional therapies for the treatment of liver metastases are used in the management of oligometastatic colorectal liver disease, especially in nonsurgical candidates. Thermal ablation (TA) is recommended in the treatment of limited liver metastases as free-standing therapy or in combination with surgery as long as all visible disease can be eradicated. Percutaneous TA has been proven as a safe and efficacious therapy offering sustained local tumor control and improved patient survival. Continuous technological advances in diagnostic imaging and guidance tools, the evolution of devices allowing for optimization of ablation parameters, as well as the ability to perform margin assessment have improved the efficacy of ablation. This allows resectable small volume diseases to be cured with percutaneous ablation. The ongoing detailed information and increasing understandi...
Nociceptive and/or neuropathic pain can be present in all phases of cancer (early and metastatic)... more Nociceptive and/or neuropathic pain can be present in all phases of cancer (early and metastatic) and are not adequately treated in 56 to 82.3% of patients. In these patients, radiotherapy achieves overall pain responses (complete and partial responses combined) up to 60 and 61%. On the other hand, nowadays, ablation is included in clinical guidelines for bone metastases and the technique is governed by level I evidence. Depending on the location of the lesion in the peripheral skeleton, either the Mirels scoring or the Harrington (alternatively the Levy) grading system can be used for prophylactic fixation recommendation. As minimally invasive treatment options may be considered in patients with poor clinical status or limited life expectancy, the aim of this review is to detail the techniques proposed so far in the literature and to report the results in terms of safety and efficacy of ablation and cementoplasty (with or without fixation) for bone metastases. Percutaneous image-gu...
Abdominopelvic trauma (APT) remains a leading cause of morbidity and mortality in the 15- to 44-y... more Abdominopelvic trauma (APT) remains a leading cause of morbidity and mortality in the 15- to 44-year-old age group in the Western World. It can be life-threatening as abdominopelvic organs, specifically those in the retroperitoneal space, can bleed profusely. APT is divided into blunt and penetrating types. While surgery is notably considered as a definitive solution for bleeding control, it is not always the optimum treatment for the stabilization of a polytrauma patient. Over the past decades, there has been a shift toward more sophisticated strategies, such as non-operative management of abdominopelvic vascular trauma for haemodynamically stable patients. Angiographic embolization for bleeding control following blunt and/or penetrating intra- and retroperitoneal injuries has proven to be safe and effective. Embolization can achieve hemostasis and salvage organs without the morbidity of surgery, and the development and refinement of embolization techniques has widened the indicati...
Vertebral augmentation has been used to treat painful vertebral compression fractures and metasta... more Vertebral augmentation has been used to treat painful vertebral compression fractures and metastatic lesions in millions of patients around the world. An international group of subject matter experts have considered the evidence, including but not limited to mortality. These considerations led them to ask whether it is appropriate to allow the subjective measure of pain to so dominate the clinical decision of whether to proceed with augmentation. The discussions that ensued are related below.
Purpose: The purpose of this study is to evaluate the efficacy and safety of Computed Tomography ... more Purpose: The purpose of this study is to evaluate the efficacy and safety of Computed Tomography (CT)-guided mediastinal biopsy. Material and Methods: This is a single centered retrospective study including 32 mediastinal biopsies performed during the last 24 months in a cohort of 29 patients (15 male-14 female, average age 57 years, lesions diameter ranging between 2-12 cm); 3 patients underwent a second biopsy due to insufficient sample post the first attempt . All percutaneous biopsies were performed under local anaesthesia and CT guidance; in all cases an 18G semi-automatic soft tissue biopsy needle was used for tissue sampling. CT scan was used for evaluation of potential complications. Results: The histological outcome was conclusive for 26/29 patients (89.6%), whilst post the second attempt efficacy rate increased to 93.7% (27/29 patients - 30/32 biopsies). Biopsy reports included lymphoma (14 cases), bronchogenic carcinoma (10 cases), metastasis (1 case) and benign substra...
Poster: "ECR 2015 / C-1461 / Imaging of low back pain: Anatomy, imaging modalities, patholog... more Poster: "ECR 2015 / C-1461 / Imaging of low back pain: Anatomy, imaging modalities, pathology and percutaneous treatments" by: "D. K. Filippiadis1, A. Mazioti2, E. Alexopoulou1, K. Malagari3, E. Brountzos4, N. L. Kelekis1, A. D. Kelekis1; 1Athens/GR, 2Pefki - Athens/GR, 3Papagou/GR, 4Haidari/GR"
European Journal of Orthopaedic Surgery & Traumatology, 2021
The purpose of this review is to become familiar with the most common indications for imaging gui... more The purpose of this review is to become familiar with the most common indications for imaging guided percutaneous bipolar radiofrequency ablation, to learn about different technical considerations during performance providing the current evidence. Controversies concerning products will be addressed. We performed a literature review excluding non-English studies and case reports. All references of the obtained articles were also evaluated for any additional information. RFA achieves cytotoxicity by raising target area temperatures above 60 °C, and may be used to achieve total necrosis of lesions smaller than 3 cm in diameter, to debulk and reduce the pain associated with larger lesions, to prevent pathological fractures due to progressive osteolysis or for cavity creation aiming for targeted cement delivery in case of posterior vertebral wall breaching. Protective ancillary techniques should be used in order to increase safety and augment efficacy of RFA in the spine. Percutaneous radiofrequency ablation of vertebral lesions is a reproducible, successful and safe procedure. Ablation should be combined with vertebral augmentation in all cases. In order to optimize maximum efficacy a patient- and a lesion-tailored approach should both be offered focusing upon clinical and performance status along with life expectancy of the patient as well as upon lesion characteristics.
Journal of Vascular and Interventional Radiology, 2021
PURPOSE To assess safety and efficacy of CT-guided radio frequency ablation (RFA) and Magnetic Re... more PURPOSE To assess safety and efficacy of CT-guided radio frequency ablation (RFA) and Magnetic Resonance guided Focused Ultrasounds (MRgFUS) in the treatment of osteoid osteoma with a long-term follow-up study (mean follow-up time longer than 2 years). MATERIALS AND METHODS Database research was carried out in two different centres with experience in musculoskeletal interventions. Both centres, one performing RFA, the other MRgFUS, identified 116 patients, who were submitted to either RFA or MRgFUS for the treatment of symptomatic osteoid osteoma and retrospectively evaluated data regarding pain scores (using a visual analogue scale). Complications were recorded according to the CIRSE classification system. Propensity score matching for multiple variables was performed. Pre- and post-therapy pain scores were compared. RESULTS Out of the 116 patients treated, 61 underwent RFA and 55 MRgFUS. The mean values of pre-treatment pain in the two groups were 9.1±0.88 (RFA) and 8.7±0.73 (MRgFUS) VAS units. Post- treatment statistically significant (p<0.00001) overall reduction in pain symptomatology was recorded. No statistically significant difference was observed between the post-treatment mean values of both groups (p=0.256). Four cases of relapse (1 RFA; 3 MRgFUS) and one complication (RFA) were observed. The analysis from propensity score matching that identified a matched cohort of 48 patients showed similar results. CONCLUSIONS Both techniques for the treatment of osteoid osteoma seem to ensure a similar pain relief. The presence of thick cortical bone over the nidus can of reduce the effectiveness of MRgFUS.
Percutaneous, image-guided musculoskeletal biopsy, due to its minimal invasive nature, when compa... more Percutaneous, image-guided musculoskeletal biopsy, due to its minimal invasive nature, when compared with open surgical biopsy, is a safe and effective technique which is widely used in many institutions as the primary method to acquire tissue and bone samples. Indications include histopathologic and molecular assessment of a musculoskeletal lesion, exclusion of malignancy in a bone/vertebral fracture, examination of bone marrow, and infection investigation. Preprocedural workup should include both imaging (for lesion assessment and staging) and laboratory (including coagulation tests and platelet count) studies. In selected cases, antibiotic prophylaxis should be administered before the biopsy. Core needle biopsy of musculoskeletal lesions has a diagnostic accuracy that ranges from 66 to 98% with higher diagnostic yield for lytic, large-size, malignant lesions and when multiple and long specimens are obtained. Reported complication rates range between 0 and 10% and usually do not e...
To evaluate clinical efficacy/safety of augmented peripheral osteoplasty in oncologic patients wi... more To evaluate clinical efficacy/safety of augmented peripheral osteoplasty in oncologic patients with long-term follow-up. Percutaneous augmented peripheral osteoplasty was performed in 12 patients suffering from symptomatic lesions of long bones. Under extensive local sterility measures, anesthesiology care, and fluoroscopic guidance, direct access to lesion was obtained and coaxially a metallic mesh consisting of 25-50 medical grade stainless steel micro-needles (22 G, 2-6 cm length) was inserted. PMMA for vertebroplasty was finally injected under fluoroscopic control. CT assessed implant position 24-h post-treatment. Clinical evaluation included immediate and delayed follow-up studies of patient&amp;amp;amp;amp;amp;amp;amp;amp;#39;s general condition, NVS pain score, and neurological status. Imaging assessed implant&amp;amp;amp;amp;amp;amp;amp;amp;#39;s long-term stability. Mean follow-up was 16.17 ± 10.93 months (range 2-36 months). Comparing patients&amp;amp;amp;amp;amp;amp;amp;amp;#39; scores prior (8.33 ± 1.67 NVS units) and post (1.42 ± 1.62 NVS units) augmented peripheral osteoplasty, there was a mean decrease of 6.92 ± 1.51 NVS units. Overall mobility improved in 12/12 patients. No complication was observed. Percutaneous augmented peripheral osteoplasty (rebar concept) for symptomatic malignant lesions in long bones seems to be a possible new technique for bone stabilization. This combination seems to provide necessary stability against shearing forces applied in long bones during weight bearing.
Sarcomas are heterogenous mesenchymal neoplasms with more than 80 different histologic subtypes. ... more Sarcomas are heterogenous mesenchymal neoplasms with more than 80 different histologic subtypes. Lung followed by liver and bone are the most common sites of sarcoma metastatic disease. Ablative techniques have been recently added as an additional alternative curative or palliative therapeutic tool in sarcoma metastatic disease. When compared to surgery, ablative techniques are less invasive therapies which can be performed even in non-surgical candidates and are related to decreased recovery time as well as preservation of the treated organ’s long-term function. Literature data upon ablative techniques for sarcoma metastatic disease are quite heterogeneous and variable regarding the size and the number of the treated lesions and the different histologic subtypes of the original soft tissue or bone sarcoma. The present study focuses upon the current role of minimal invasive thermal ablative techniques for the management of metastatic sarcoma disease. The purpose of this review is to...
Transforaminal infiltrations in the cervical spine are governed by a higher rate of vascular punc... more Transforaminal infiltrations in the cervical spine are governed by a higher rate of vascular puncture than in the lumbar spine. The purpose of our study is to assess the safety and efficacy of percutaneous, fluoroscopically guided nerve root infiltrations in cases of cervical radiculopathy. An indirect postero-lateral approach was performed through the ipsilateral facet joint. During the last 2 years, 25 patients experiencing cervical radiculopathy underwent percutaneous, fluoroscopically guided nerve root infiltrations by means of an indirect postero-lateral approach through the ipsilateral facet joint. The intra-articular position of the needle (22-gauge spinal needle) was fluoroscopically verified after injection of a small amount of contrast medium which also verified dispersion of the contrast medium periradicularly and in the epidural space. Then a mixture of long-acting glucocorticosteroid diluted in normal saline (1.5/1 mL) was injected intra-articularly. A questionnaire wit...
Approximately 50% of colorectal cancer patients will develop metastases during the course of the ... more Approximately 50% of colorectal cancer patients will develop metastases during the course of the disease. Local or locoregional therapies for the treatment of liver metastases are used in the management of oligometastatic colorectal liver disease, especially in nonsurgical candidates. Thermal ablation (TA) is recommended in the treatment of limited liver metastases as free-standing therapy or in combination with surgery as long as all visible disease can be eradicated. Percutaneous TA has been proven as a safe and efficacious therapy offering sustained local tumor control and improved patient survival. Continuous technological advances in diagnostic imaging and guidance tools, the evolution of devices allowing for optimization of ablation parameters, as well as the ability to perform margin assessment have improved the efficacy of ablation. This allows resectable small volume diseases to be cured with percutaneous ablation. The ongoing detailed information and increasing understandi...
Nociceptive and/or neuropathic pain can be present in all phases of cancer (early and metastatic)... more Nociceptive and/or neuropathic pain can be present in all phases of cancer (early and metastatic) and are not adequately treated in 56 to 82.3% of patients. In these patients, radiotherapy achieves overall pain responses (complete and partial responses combined) up to 60 and 61%. On the other hand, nowadays, ablation is included in clinical guidelines for bone metastases and the technique is governed by level I evidence. Depending on the location of the lesion in the peripheral skeleton, either the Mirels scoring or the Harrington (alternatively the Levy) grading system can be used for prophylactic fixation recommendation. As minimally invasive treatment options may be considered in patients with poor clinical status or limited life expectancy, the aim of this review is to detail the techniques proposed so far in the literature and to report the results in terms of safety and efficacy of ablation and cementoplasty (with or without fixation) for bone metastases. Percutaneous image-gu...
Abdominopelvic trauma (APT) remains a leading cause of morbidity and mortality in the 15- to 44-y... more Abdominopelvic trauma (APT) remains a leading cause of morbidity and mortality in the 15- to 44-year-old age group in the Western World. It can be life-threatening as abdominopelvic organs, specifically those in the retroperitoneal space, can bleed profusely. APT is divided into blunt and penetrating types. While surgery is notably considered as a definitive solution for bleeding control, it is not always the optimum treatment for the stabilization of a polytrauma patient. Over the past decades, there has been a shift toward more sophisticated strategies, such as non-operative management of abdominopelvic vascular trauma for haemodynamically stable patients. Angiographic embolization for bleeding control following blunt and/or penetrating intra- and retroperitoneal injuries has proven to be safe and effective. Embolization can achieve hemostasis and salvage organs without the morbidity of surgery, and the development and refinement of embolization techniques has widened the indicati...
Uploads
Papers