A short review of basic head and neck interventional procedures in a general radiology department

Abstract

Image-guided interventional procedures provide a safe way to diagnose and treat a variety of head and neck abnormalities. The procedure time is usually short, and most procedures can be performed on an outpatient basis. Knowledge about strengths and weaknesses, efficacy, potential complications, and pitfalls of these procedures allows the best treatment to be chosen for a particular lesion type. This review discusses some of the commonly performed interventional radiology procedures in a general radiology department in the management of patients with neoplastic diseases in the head and neck region.

Figure 1

Side-cutting needle consists of the outer cutting shaft and the inner stylet with a specimen notch. With the needle tip positioned at the target tissue edge, the inner stylet is advanced into the target tissue, which will partly prolapse into the specimen notch. The specimen is obtained by advancing the outer cutting shaft to resheath the inner stylet and cut out the specimen core.

Figure 2

End-cutting needles comprise an inner stylet and an outer trocar. The technique of using the end-cutting needle is similar to that for the use of fine needles for aspiration cytology. There are different designs of the configuration of the tip of the end-cutting needles, and this example shows the serrated cutting end of the Franseen needle.

Figure 3

(A) Power Doppler ultrasound shows a metastatic node from papillary thyroid carcinoma with prominent vascularity. (B) The needle is first positioned at the deepest part of the metastatic node. (C) Ethanol injected into the metastatic node appears echogenic. (D) The needle tip is repositioned at another site for further injection until the entire node is adequately treated.

Figure 4

Ultrasonogram shows normal appearance of the left larynx: vocal fold (arrowhead), arytenoid (arrow); the injecting needle (open arrow) is inserted into the right vocal fold via the transcutaneous transcartilage approach.

Figure 5

Thermal lesion formed around active tip of RF electrode.

Figure 6

(A) Internally cooled RF electrode for thyroid lesion: 7 cm long, 18-gauge (Apro Korea, CoATherm Ice). (B) Close-up view of active tips: 5 mm, 7 mm, and 10 mm.

Figure 7

Trans-isthmic approach. Blue line represents RFA electrode. Orange and yellow spheres represent thermal lesion. Danger triangle is enclosed by red dotted line. Yellow dot represents recurrent laryngeal nerve. The esophagus is shown in pink.

Figure 8

Sequential transverse ultrasound-guided image of the right lobe of thyroid during RFA via trans-isthmic approach. (A) RFA needle (white arrowheads) in situ. Active tip (open arrowhead) and thyroid nodule (arrows). (B) Echogenic change (open arrows) around the active tip represents thermocoagulation. Note the echogenic change that obscures posterior visualization (asterisk).