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Review
. 2018 Oct;35(4):342-349.
doi: 10.1055/s-0038-1673362. Epub 2018 Nov 5.

Global Approach to the Patient with Pain in Interventional Radiology

Ross W Bittman  1 , Eric B Friedberg  1 , Howard B Fleishon  1   2 , J David Prologo  1
Affiliations
Review

Global Approach to the Patient with Pain in Interventional Radiology

Ross W Bittman et al. Semin Intervent Radiol. 2018 Oct.
No abstract available

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Figures

Fig. 1
Fig. 1
Global approach to the patient with pain.
Fig. 2
Fig. 2
Algorithm for the evaluation of a painful metastatic lesion involving the spine.
Fig. 3
Fig. 3
( a , b ) Axial and sagittal CT images of a 57-year-old man with a history of lung cancer presenting with lumbar spine pain demonstrating lytic metastases involving L5 ( arrows ). ( c ) Intraprocedural anteroposterior (AP) image demonstrates a unipediculate coaxial, transpedicular approach from the left with a coaxially placed radiofrequency ablation probe ( arrow ) in the affected vertebral body. ( d ) Final image from RFA and cementoplasty demonstrates distribution of cement corresponding to the original lesion and fracture, providing stabilization.
Fig. 4
Fig. 4
Algorithm for the evaluation of a painful metastatic lesion outside of the spine.
Fig. 5
Fig. 5
Axial intraprocedural CT images demonstrate a proximal femoral osteoid osteoma ( arrow ) in a 29-year-old man ( a ), subsequent juxtacortical percutaneous image-guided placement of a 17-gauge cryoablation probe ( b , arrow ), and demonstration of target lesion inclusion by the visualized ablation zone ( c , arrows ).
Fig. 6
Fig. 6
( a ) A coronal fused image of a 71-year-old man with a history of non-small cell lung cancer and left chest wall pain demonstrates abnormal uptake of radiopharmaceutical about a left lateral rib ( arrow ), corresponding with his chief complaint. ( b ) Single axial intraprocedural CT image demonstrates placement of a 17-gauge cryoablation probe to the center of the lesion and the associated early ablation zone ( arrow ). In cases such as these, additional cryoablation probes or extension of freeze times are warranted to include the entirety of the lesion.
Fig. 7
Fig. 7
An algorithm for the management of nonneoplastic spine pain.
Fig. 8
Fig. 8
( a ) Single axial T2-weighted MRI image demonstrates a left-side L5 asymmetric partial intervertebral disc herniation ( arrow ), corresponding to the patients presenting complaint. ( b ) Corresponding intraprocedural fluoroscopic image from a left-side L5 transforaminal injection demonstrates contrast outlining the affected exiting nerve root ( arrow ), confirming appropriate needle position.
Fig. 9
Fig. 9
( a ) Single axial T1-weighted MRI image of the lumbar spine demonstrates the shape and location of the midline epidural space ( arrow ). ( b ) Corresponding intraprocedural fluoroscopic image demonstrates contrast outlining the midline epidural space ( arrows ), confirming appropriate needle position.
Fig. 10
Fig. 10
Percutaneous cryoneurolysis algorithm.
Fig. 11
Fig. 11
( a ) Relevant planning landmarks for intervention to the pudendal canal. Axial CT scan from diagnostic pudendal nerve injection procedure ( left ) and corresponding anatomical landmarks ( right ). ( b ) Single axial postprocedure CT image from a pudendal nerve infiltration, demonstrating fluid in the pudendal canal ( arrow ). ( c ) Corresponding image from the subsequent cryoablation procedure, demonstrating placement of a 17-gauge cryoablation probe ( arrow ) in the ischiorectal fat adjacent to the nerve.
Fig. 12
Fig. 12
( a ) Relevant planning landmarks for intervention in the setting of refractory inguinodynia ( left ) and corresponding anatomical landmarks ( right ). ( b ) Preprocedural T1 fat-saturated axial MR image from a patient with longstanding inguinodynia demonstrates fibrosis and stranding about the ilioinguinal and genitofemoral nerves ( arrows ), deep to implanted mesh. ( c ) Corresponding intraprocedural CT image from a cryoneurolysis procedure, demonstrating placement of the cryoablation probe ( arrow ) and warm saline protecting the overlying skin ( arrowheads ).
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