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Musculoskeletal Ablation and Embolization
Brandt C. Wible, MD; Ashraf Thabet, MD
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KEY FACTS

  • Preprocedure

    • Procedure

      • Outcomes

        TERMINOLOGY

        • Definitions

          • Cryoablation
            • Lethal ice < 20-40 °C, repeated freeze-thaw cycles disrupt cell membranes
            • CT/US can visualize ice in real time during ablation
            • May be used in palliative debulking
            • Specialized gases (e.g., argon, helium) required
            • Multiple probes most often required
          • Microwave ablation (MWA)
            • Alternating electromagnetic fields oscillate water molecules, which heat to lethal °C
            • Ablation zone independent of tissue conductivity
            • Some probes internally cooled with saline
          • Radiofrequency ablation (RFA)
            • > 60 °C at probe, thermal conduction within tissue results in expansion of ablation zone
              • ↓ bone conductivity results in smaller ablation zones
            • Most often used in osteoid osteoma
            • Radiofrequency probe, monopolar or bipolar
              • Single-needle design usually sufficient
              • Grounding pads (if monopolar probe)
              • Some probes internally cooled with saline
          • Irreversible electroporation (IRE)
            • Nonthermal; high-voltage pulses result in irreversible pores in cell membranes resulting in cell death without loss of surrounding stroma
          • Tissue dissection
            • Spatially separate tissues, displacing nontarget tissues > 1.5 cm from edge of lethal ablation zone
            • 5% dextrose (D₅W) for RFA; saline or air for non-RFA
          • Osteoid osteoma: Benign tumor arising from osteoblasts
            • Has central nidus of growing cells
              • Surrounded by hard shell of thickened bone
            • Most common in long bones (e.g., femur, tibia)
            • Most common in patients ages 4-25 years
              • Males affected 3x > females
            • Clinical presentation
              • Nighttime pain relieved by NSAIDs

        PREPROCEDURE

        • Indications

          • Contraindications

            • Preprocedure Imaging

              • Getting Started

                PROCEDURE

                • Patient Position/Location

                  • Procedure Steps

                    • Alternative Procedures/Therapies

                      POST PROCEDURE

                      • Things to Do

                        • Things to Avoid

                          • Postprocedure Imaging

                            OUTCOMES

                            • Problems

                              • Complications

                                • Expected Outcomes

                                  Selected References

                                  1. Parvinian A et al: Trends in musculoskeletal ablation: emerging indications and techniques. Tech Vasc Interv Radiol. 23(2):100678, 2020
                                  2. Moynagh MR et al: Thermal ablation of bone metastases. Semin Intervent Radiol. 35(4):299-308, 2018
                                  3. Kurup AN et al: Ablation of musculoskeletal metastases. AJR Am J Roentgenol. 209(4):713-21, 2017
                                  4. Hartung MP et al: Safety and efficacy of minimally invasive acetabular stabilization for periacetabular metastatic disease with thermal ablation and augmented screw fixation. J Vasc Interv Radiol. 27(5):682-8.e1, 2016
                                  5. Nazario J et al: Thermal ablation of painful bone metastases. Tech Vasc Interv Radiol. 14(3):150-9, 2011
                                  6. Dupuy DE et al: Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial. Cancer. 116(4):989-97, 2010
                                  7. Kurup AN et al: Ablation of skeletal metastases: current status. J Vasc Interv Radiol. 21(8 Suppl):S242-50, 2010
                                  8. Brace CL: Radiofrequency and microwave ablation of the liver, lung, kidney, and bone: what are the differences? Curr Probl Diagn Radiol. 38(3):135-43, 2009
                                  9. Motamedi D et al: Thermal ablation of osteoid osteoma: overview and step-by-step guide. Radiographics. 29(7):2127-41, 2009
                                  10. Rosenthal DI: Radiofrequency treatment. Orthop Clin North Am. 37(3):475-84, viii, 2006
                                  11. Rosenthal DI et al: Osteoid osteoma: percutaneous treatment with radiofrequency energy. Radiology. 229(1):171-5, 2003
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Preprocedure

                                    • Procedure

                                      • Outcomes

                                        TERMINOLOGY

                                        • Definitions

                                          • Cryoablation
                                            • Lethal ice < 20-40 °C, repeated freeze-thaw cycles disrupt cell membranes
                                            • CT/US can visualize ice in real time during ablation
                                            • May be used in palliative debulking
                                            • Specialized gases (e.g., argon, helium) required
                                            • Multiple probes most often required
                                          • Microwave ablation (MWA)
                                            • Alternating electromagnetic fields oscillate water molecules, which heat to lethal °C
                                            • Ablation zone independent of tissue conductivity
                                            • Some probes internally cooled with saline
                                          • Radiofrequency ablation (RFA)
                                            • > 60 °C at probe, thermal conduction within tissue results in expansion of ablation zone
                                              • ↓ bone conductivity results in smaller ablation zones
                                            • Most often used in osteoid osteoma
                                            • Radiofrequency probe, monopolar or bipolar
                                              • Single-needle design usually sufficient
                                              • Grounding pads (if monopolar probe)
                                              • Some probes internally cooled with saline
                                          • Irreversible electroporation (IRE)
                                            • Nonthermal; high-voltage pulses result in irreversible pores in cell membranes resulting in cell death without loss of surrounding stroma
                                          • Tissue dissection
                                            • Spatially separate tissues, displacing nontarget tissues > 1.5 cm from edge of lethal ablation zone
                                            • 5% dextrose (D₅W) for RFA; saline or air for non-RFA
                                          • Osteoid osteoma: Benign tumor arising from osteoblasts
                                            • Has central nidus of growing cells
                                              • Surrounded by hard shell of thickened bone
                                            • Most common in long bones (e.g., femur, tibia)
                                            • Most common in patients ages 4-25 years
                                              • Males affected 3x > females
                                            • Clinical presentation
                                              • Nighttime pain relieved by NSAIDs

                                        PREPROCEDURE

                                        • Indications

                                          • Contraindications

                                            • Preprocedure Imaging

                                              • Getting Started

                                                PROCEDURE

                                                • Patient Position/Location

                                                  • Procedure Steps

                                                    • Alternative Procedures/Therapies

                                                      POST PROCEDURE

                                                      • Things to Do

                                                        • Things to Avoid

                                                          • Postprocedure Imaging

                                                            OUTCOMES

                                                            • Problems

                                                              • Complications

                                                                • Expected Outcomes

                                                                  Selected References

                                                                  1. Parvinian A et al: Trends in musculoskeletal ablation: emerging indications and techniques. Tech Vasc Interv Radiol. 23(2):100678, 2020
                                                                  2. Moynagh MR et al: Thermal ablation of bone metastases. Semin Intervent Radiol. 35(4):299-308, 2018
                                                                  3. Kurup AN et al: Ablation of musculoskeletal metastases. AJR Am J Roentgenol. 209(4):713-21, 2017
                                                                  4. Hartung MP et al: Safety and efficacy of minimally invasive acetabular stabilization for periacetabular metastatic disease with thermal ablation and augmented screw fixation. J Vasc Interv Radiol. 27(5):682-8.e1, 2016
                                                                  5. Nazario J et al: Thermal ablation of painful bone metastases. Tech Vasc Interv Radiol. 14(3):150-9, 2011
                                                                  6. Dupuy DE et al: Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial. Cancer. 116(4):989-97, 2010
                                                                  7. Kurup AN et al: Ablation of skeletal metastases: current status. J Vasc Interv Radiol. 21(8 Suppl):S242-50, 2010
                                                                  8. Brace CL: Radiofrequency and microwave ablation of the liver, lung, kidney, and bone: what are the differences? Curr Probl Diagn Radiol. 38(3):135-43, 2009
                                                                  9. Motamedi D et al: Thermal ablation of osteoid osteoma: overview and step-by-step guide. Radiographics. 29(7):2127-41, 2009
                                                                  10. Rosenthal DI: Radiofrequency treatment. Orthop Clin North Am. 37(3):475-84, viii, 2006
                                                                  11. Rosenthal DI et al: Osteoid osteoma: percutaneous treatment with radiofrequency energy. Radiology. 229(1):171-5, 2003