Current role and future applications of image-guided interventional procedures in musculoskeletal oncology - A narrative review

Abstract

Background: Musculoskeletal (MSK) image-guided interventional procedures have been increasingly used in and remain crucial in the diagnosis and treatment of musculoskeletal tumours.

Aims: In this article, we aim to describe commonly performed interventional procedures in the subspeciality of MSK oncology drawing experience from our tertiary referral centre. Recent advances, emerging techniques and future applications of image-guided interventional procedures in the field of MSK oncology are highlighted.

Material and methods: A retrospective search using the keyword 'musculoskeletal system', 'neoplasms', 'biopsy', and 'interventional radiology' was performed at our tertiary care oncology orthopaedic referral centre radiology database. The radiology images were collected from our Picture Archiving and Communication System (PACS) and Radiology Information System (RIS). Electronic Patient Records, histopathology laboratory records and patient characteristics were collaborated to generate this narrative experience at our centre.

Results: Image-guided interventional procedures have been utilised in a spectrum of primary and secondary MSK tumours. Current applications include diagnosis of bone and soft tissue MSK neoplastic lesions with biopsies, thermal, cryotherapy and Radiofrequency ablations and augmentation procedures.

Conclusion: Musculoskeletal (MSK) image-guided interventions have increasing applications in the diagnosis, management, treatment and monitoring of patients with MSK tumours. The emergence of newer imaging technologies with enhanced skills of interventional radiologists will allow a range of therapeutic MSK interventions in both effective control of primary lesions and palliative care of metastatic lesions.

Keywords: Biopsy; Interventional; Musculoskeletal system; Neoplasms; Oncology; Radiology.

Fig. 1

US guided biopsy – T1 axial (a) and T2 coronal (b) images of the foot demonstrating a heterogenous lesion in the 1st web space. US image visualizing the position of the biopsy needle in the lesion (c).

Fig. 2

Fluoroscopic guided biopsy and vertebroplasty of the L1 lesion – Sagittal T1 and Proton density fat saturated images of the spine demonstrating multiple vertebral lesions with pathological fracture of L1 (a and b). Biopsy and vertebroplasty of the L1 was done under fluoroscopic guidance, Image c demonstrating position of the needle and d showing post vertebroplasty cement in L1.

Fig. 3

CT guidance for deep seated intraarticular synovial lesion – Sagittal T1 (a) and axial PDFS images (b) demonstrating a soft tissue lesion in the posterior aspect of the knee joint (arrow). CT guided biopsy of the lesion using a coaxial biopsy system (c) which confirmed the diagnosis of pigmented villonodular synovitis.

Fig. 4

CT guided bone biopsy – Axial PDFS MRI images demonstrating a hyperintense lesion in the right pubic bone (a). CT guided biopsy (b) confirmed the diagnosis of chondrosarcoma.

Fig. 5

Sclerotherapy for ABC- Proton density fat saturated axial MRI image (a) demonstrating an aneurismal bone cyst in the femoral head with fluid levels (arrow). CT images demonstrating needle position in the lesion (b) following aspiration of the contents, contrast material was injected into the lesion followed by sclerosants (c).

Fig. 6

RFA of osteoid osteoma – Axial proton density fat saturated images demonstrating marrow oedema in the proximal femur (a). Corresponding T1 axial image (b) demonstrates a small cortical lesion (arrow). Axial CT image at this level confirms osteoid osteoma (c). CT guided RFA was performed, image (d) demonstrating the position of the electrode within the lesion.

Fig. 7

CT guided Cryoablation – T1 and Proton density fat saturated axial images of the pelvis demonstrating a left posterior sacral chondromyxoid fibroma (a and b). Coronal and sagittal reformatted CT images (c and d) demonstrating position of the cryoprobes within the lesion.

Fig. 8

CT guided Cryoablation – Axial CT image demonstrating a lytic lesion in the left acetabulum (a). Axial CT post cementoplasty shows lesion augmented with cement (b) (arrow). .