Kaufman J.A. Vascular and interventional radiology: the requisites / J.A.Kaufman, M.J.Lee. - 2nd ed. - Philadelphia: Elsevier/Saunders, 2014. - xxi, 597 p.: ill. - (Requisites) (Requisites in radiology series). - Bibliogr. at the end of the chapters. - Ind.: p.581-597. - ISBN 978-0-323-04584-1  Место хранения:   02 | Отделение ГПНТБ СО РАН | Новосибирск

Оглавление / Contents

Chapter 1 Mascular Pathology .............................................. i А. Kaufman, MD, MS, FSIR, FCIRSE The Normal Vascular Wall ........................................ 1 Atherosclerosis ................................................. 2 Ujntimal Hyperplasia ............................................ 3 Aneurysms ....................................................... 4 Fibromuscular Dysplasia ......................................... 5 (Vasculitis ..................................................... 6 Hemangiomas, Vascular Malformations, and Arteriovenous Fistulas ..................................................... 9 Neoplasms ...................................................... 12 Dissection ..................................................... 13 Trauma ......................................................... 14 Vasospastic Disorders .......................................... 15 Arterial Embolism .............................................. 15 Infection ...................................................... 16 Inherited Disorders of the Arterial Wall ....................... 17 Impingement Syndromes .......................................... 20 Adventitial Cystic Disease ..................................... 21 Mönckeberg Sclerosis ........................................... 21 Thrombosis ..................................................... 21 Suggested Readings ............................................. 24 Chapter 2 Fundamentals of Angiography .................................... 25 John A. Kaufman, MD, MS, FSIR, FCIRSE Preprocedure Patient Evaluation and Management ...................................... 25 Basic Safety Considerations .................................... 26 Tools .......................................................... 27 Access Needles ................................................. 27 Guidewires ..................................................... 27 Dilators ....................................................... 29 Catheters ...................................................... 29 Sheaths ........................................................ 33 Stopcocks/Flow Switches ........................................ 34 Contrast Agents ................................................ 34 Alternative Contrast Agents .................................... 35 Carbon Dioxide Gas ............................................. 35 Gadolinium Chelates ............................................ 38 Intraprocedural Care ........................................... 38 Sedation ....................................................... 38 Antibiotic Prophylaxis ......................................... 38 Blood Pressure Control ......................................... 39 Carcinoid Crisis ............................................... 40 Anticoagulation ................................................ 40 Pediatric Patients ............................................. 40 The Arterial Puncture .......................................... 40 General Considerations ......................................... 40 Common Femoral Artery .......................................... 40 Axillary or High Brachial Artery ............................... 44 Translumbar Aorta .............................................. 45 Unusual Arterial Access ........................................ 46 The Venous Puncture ............................................ 46 Common Femoral Vein ............................................ 46 Internal Jugular Vein .......................................... 47 Subclavian Vein ................................................ 48 Upper Extremity Veins .......................................... 48 Inferior Vena Cava ............................................. 49 Other Venous Access ............................................ 49 Angiographic "Do's and Don'ts" ................................. 49 Imaging ........................................................ 51 Digital Subtraction Angiography ................................ 51 Procedural Issues .............................................. 52 Intravascular Ultrasound ....................................... 53 Postprocedure Care ............................................. 53 Suggested Readings ............................................. 54 Chapter 3 Noninvasive Vascular Imaging ................................... 56 John A. Kaufman, MD, MS, FSIR, FCIRSE, and Constantino S. Репа, MD Ultrasound ..................................................... 56 Grayscale Ultrasound ........................................... 56 Doppler Ultrasound ............................................. 56 Color Doppler .................................................. 58 Power Doppler .................................................. 58 Ultrasound Contrast Agents ..................................... 59 Magnetic Resonance Imaging and Magnetic Resonance Angiography .. 59 Computed Tomography and Computed Tomography Angiography ........ 61 Postprocessing ................................................. 64 Suggested Readings ............................................. 67 Chapter 4 Vascular Interventions ......................................... 68 John A. Kaufman, MD, MS, FSIR, FCIRSE Improving the Lumen ...... 68 Fundamentals ................................................... 68 Balloon Angioplasty ............................................ 73 Embolic Protection Devices ..................................... 76 Stents ......................................................... 76 Stent-Grafts ................................................... 80 Debulking Atheroma ............................................. 81 Pharmacologic Thrombolysis ..................................... 81 Mechanical Thrombectomy ........................................ 84 Pharmacomechanical Thrombolysis ................................ 85 Vasodilating Drugs ............................................. 85 Decreasing Blood Flow Through Vessels .......................... 86 Fundamentals ................................................... 86 Embolization ................................................... 87 Endovascular Ablation .......................................... 91 Vasoconstricting Drugs ......................................... 94 Treatment of Arterial Access Pseudoaneurysms ................... 95 Implanting Devices ............................................. 95 Taking Things Out of Blood Vessels ............................. 95 Intravascular Foreign Body Retrieval ........................... 95 Transvascular Biopsy ........................................... 97 Suggested Readings ............................................. 98 Chapter 5 Carotid and Vertebral Arteries ................................. 99 John A. Kaufman, MD, MS, FSIR, FCIRSE, and Саry M. Nesbit, MD Anatomy ........................................................ 99 Key Collateral Pathways ........................................ 99 Imaging ....................................................... 100 Atherosclerotic Occlusive Disease ............................. 103 Fibromuscular Dysplasia ....................................... 109 Vasculitis .................................................... 110 Spontaneous Carotid and Vertebral Dissection .................. 110 Trauma ........................................................ 111 Epistaxis ..................................................... 113 Carotid Body Tumors ........................................... 113 Head and Neck Malignancy ...................................... 113 Stroke Therapy ................................................ 113 Suggested Readings ............................................ 118 Chapter 6 Upper Extremity Arteries ...................................... 119 John A. Kaufman, MD, MS, FSIR, FCIRSE Normal and Variant Anatomy .................................... 119 Key Collateral Pathways ....................................... 121 Imaging ....................................................... 122 Vasospastic Disorders ......................................... 123 Chronic Ischemia .............................................. 124 Acute Ischemia ................................................ 126 Thoracic Outlet Syndrome ...................................... 128 Aneurysms ..................................................... 129 Vasculitis .................................................... 130 Trauma ........................................................ 131 Fibromuscular Dysplasia ....................................... 134 Primary Hyperparathyroidism ................................... 134 Suggested Readings ............................................ 135 Chapter 7 Upper Extremity, Neck, and Central Thoracic Veins ............. 136 John A. Kaufman, MD, MS, FSIR, FCIRSE Anatomy ....................................................... 136 Veins of the Neck ............................................. 136 Veins of the Upper Extremities ................................ 136 Central Thoracic Veins ........................................ 137 Imaging ....................................................... 139 Upper Extremity Venous Thrombosis ............................. 140 Thoracic Outlet Syndrome ...................................... 142 Superior Vena Cava Syndrome ................................... 144 Central Venous Access ......................................... 145 Basic Principles of Device Implantation ....................... 146 Complications of Venous Access Devices ........................ 148 Device Removal ................................................ 150 Permanent Dialysis Access ..................................... 151 Angioplasty and Stents ........................................ 153 Management of the Thrombosed Dialysis Access .................. 154 Pharmacologic Thrombolysis .................................... 155 Percutaneous Mechanical Thrombectomy .......................... 156 Percutaneous Pharmacomechanical Thrombectomy .................. 156 Complications of Dialysis Access Declotting Procedures ........ 157 Chronic Cerebrospinal Venous Insufficiency .................... 157 Suggested Readings ............................................ 158 Chapter 8 Pulmonary Circulation ......................................... 159 John A. Kaufman, MD, MS, FSIR, FCIRSE Anatomy ....................................................... 159 Key Collateral Pathways ....................................... 160 Imaging ....................................................... 161 Pulmonary Circulation ......................................... 161 Bronchial Arteries ............................................ 164 Acute Pulmonary Embolism ...................................... 164 Chronic Pulmonary Embolism .................................... 168 Pulmonary Artery Stenosis ..................................... 169 Pulmonary Vascular Malformations .............................. 169 Pulmonary Sequestration ....................................... 171 Pulmonary Artery Tumors ....................................... 172 Pulmonary Artery Aneurysms and Pseudoaneurysms ................ 172 Bronchial Artery Bleeding ..................................... 174 Suggested Readings ............................................ 176 Chapter 9 Thoracic Aorta ................................................ 177 John A. Kaufman, MD, MS, FSIR, FCIRSE Normal Anatomy ................................................ 177 Key Collateral Pathways ....................................... 179 Imaging ....................................................... 179 Aneurysms ..................................................... 183 Ascending Aortic Aneurysms .................................... 184 Aneurysms of the Transverse Arch .............................. 185 Aneurysms of the Descending Thoracic Aorta .................... 185 Aortic Dissection ............................................. 188 Intramural Hematoma ........................................... 192 Penetrating Aortic Ulcers ..................................... 192 Trauma ........................................................ 193 Vasculitis .................................................... 195 Coarctation ................................................... 195 Thoracic Duct Leak Embolization ............................... 196 Suggested Readings ............................................ 198 Chapter 10 Abdominal Aorta and Pelvic Arteries ........................... 199 John A. Kaufman, MD, MS, FSIR, FCIRSE Normal and Variant Anatomy .................................... 199 Abdominal Aorta ............................................... 199 Iliac Arteries and Their Branches ............................. 199 Key Collateral Pathways ....................................... 201 Imaging ....................................................... 202 Aneurysms ..................................................... 203 Occlusive Disease ............................................. 209 Dissection .................................................... 214 Infection ..................................................... 217 Embolic Occlusion ............................................. 218 Vasculitis .................................................... 219 Miscellaneous ................................................. 219 Trauma ........................................................ 220 Uterine Artery Embolization ................................... 222 Uterine Fibroids .............................................. 222 Other Gynecologic Indications ................................. 225 Embolization of the Bladder ................................... 226 Penile Angiography ............................................ 226 Prostatic Embolization for Benign Hyperplasia ................. 227 Suggested Readings ............................................ 228 Chapter 11 Visceral Arteries ............................................. 229 John A. Kaufman, MD, MS, FSIR, FCIRSE Normal Anatomy ................................................ 229 Celiac Artery ................................................. 229 Liver (Arterial Supply) ....................................... 229 Spleen ........................................................ 229 Stomach ....................................................... 230 Pancreas ...................................................... 230 Superior Mesenteric Artery .................................... 230 Inferior Mesenteric Artery .................................... 231 Key Collateral Pathways ....................................... 232 Celiac Artery ................................................. 232 Spleen ........................................................ 232 Liver ......................................................... 232 Superior Mesenteric Artery .................................... 234 Inferior Mesenteric Artery .................................... 234 Imaging ....................................................... 234 Acute Mesenteric Ischemia ..................................... 236 Chronic Mesenteric Ischemia ................................... 238 Gastrointestinal Bleeding ..................................... 239 Acute Gastrointestinal Bleeding ............................... 239 Chronic Gastrointestinal Bleeding ............................. 243 Neoplasm ...................................................... 244 Bowel ......................................................... 244 Pancreas ...................................................... 244 Hepatic Neoplasms ............................................. 246 Bland Embolization ............................................ 248 Chemoembolissation ............................................ 249 Drug-Eluting Beads ............................................ 250 Yttrium-90 Radioembolization .................................. 250 Colon Metastases .............................................. 252 Neuroendocrine Metastases ..................................... 252 Other Metastatic Tumors ....................................... 253 Liver Transplantation ......................................... 254 Trauma ........................................................ 255 Liver ......................................................... 255 Spleen ........................................................ 256 Bowel ......................................................... 256 Visceral Artery Aneurysms ..................................... 256 Fibromuscular Dysplasia ....................................... 258 Segmental Arterial Mediolysis ................................. 258 Dissection .................................................... 258 Vascular Malformations ........................................ 259 Vasculitis .................................................... 260 Hypersplenism ................................................. 260 Splenic Steal Syndrome ........................................ 262 Suggested Readings ............................................ 264 Chapter 12 Renal Arteries ................................................ 265 John A. Kaufman, MD, MS, FSIR, FCIRSE Anatomy ....................................................... 265 Renal Arteries ................................................ 265 Adrenal Arteries .............................................. 265 Key Collateral Pathways ....................................... 265 Imaging ....................................................... 266 Renal Arteries ................................................ 266 Adrenal Arteries .............................................. 268 Renal Artery Occlusive Disease ................................ 268 Renal Denervation for Hypertension ............................ 276 Acute Renal Ischemia .......................................... 276 Renal Artery Aneurysms ........................................ 277 Neoplasm ...................................................... 278 Angiomyolipoma ................................................ 278 Oncocytoma .................................................... 279 Metanephric Adenoma ........................................... 280 MKnai Gell Carcinoma .......................................... 280 Wilms Tumor ................................................... 281 Metastatic Disease ............................................ 281 Renal Transplantation ......................................... 281 Trauma ........................................................ 283 Arteriovenous Malformations and Fistulas ...................... 284 Renal Ablation ................................................ 284 Pheochromocytoma .............................................. 284 Suggested Readings ............................................ 286 Chapter 13 Inferior Vena Cava and Tributaries ............................ 287 John A. Kaufman, MD, MS, FSIR, FCIRSE Normal Anatomy ................................................ 287 Key Collateral Pathways ....................................... 291 Imaging ....................................................... 292 Inferior Vena Cava Obstruction ................................ 293 Vena Cava Filters ............................................. 296 Filter Placement .............................................. 297 Filter Retrieval or Conversion ................................ 300 Tumors ........................................................ 301 Trauma ........................................................ 303 Renal Vein Thrombosis ......................................... 303 Renal Vein Varices/Nutcracker Syndrome ........................ 304 Pelvic Congestion Syndrome .................................... 304 Varicocele Embolization ....................................... 306 Adrenal Venous Sampling ....................................... 306 Primary Hyperaldosteronism .................................... 306 Other Disorders ............................................... 307 Suggested Readings ............................................ 308 Chapter 14 Portal and Hepatic Veins ...................................... 309 John A. Kaufman, MD, MS, FSIR, FCIRSE, and Peter J. Bromley, MD, FRCPC Anatomy ....................................................... 309 Hepatic Segmentation .......................................... 309 Venous Anatomy ................................................ 309 Key Collateral Pathways ....................................... 310 Imaging ....................................................... 311 Portal Hypertension ........................................... 315 Transjugular Intrahepatic Portosystemic Shunt ................. 318 Direct Inferior Vena Cava to Portal Shunt ..................... 325 Balloon Retrograde Transrenal Obliteration of Gastric Varices .................................................... 325 Partial Splenic Embolization .................................. 326 Hepatic Vein Obstruction/Budd-Chiari Syndrome ................. 326 Prehepatic Portal Venous Thrombosis/Occlusion ................. 327 Portal Vein Thrombosis ........................................ 329 Splenic Vein Thrombosis ....................................... 329 Mesenteric Venous Thrombosis .................................. 330 Posttransplant Portal Vein Stenosis ........................... 330 Neoplasm ...................................................... 330 Portal Vein Embolization ...................................... 331 Transjugular Liver Biopsy ..................................... 332 Suggested Readings ............................................ 333 Chapter 15 Lower-Extremity Arteries ...................................... 334 John A. Kaufman, MD, MS, FSIR, FCIRSE Anatomy ....................................................... 334 Key Collateral Pathways ....................................... 337 Noninvasive Physiologic Evaluation ............................ 337 Imaging ....................................................... 339 Chronic Occlusive Disease ..................................... 343 Percutaneous Superficial Femoral Artery and Popliteal Interventions .............................................. 347 Tibial Artery Angioplasty and Stents .......................... 350 Acute Limb Ischemia ........................................... 351 Blue Toe Syndrome ............................................. 353 Aneurysms ..................................................... 354 Popliteal Artery Aneurysm ..................................... 355 Common Femoral Artery Aneurysm ................................ 355 Persistent Sciatic Artery Aneurysm ............................ 356 Arteriomegaly ................................................. 357 Trauma ........................................................ 357 Penetrating Trauma ............................................ 357 Knee Dislocation .............................................. 358 Vasculitis .................................................... 359 Popliteal Artery Entrapment ................................... 360 Adventitial Cystic Disease .................................... 361 Ergotism ...................................................... 361 Reconstructive Surgery ........................................ 362 Arteriovenous Malformations ................................... 363 Suggested Readings ............................................ 363 Chapter 16 Lower-Extremity Veins ......................................... 365 John A. Kaufman, MD, MS, FSIR, FCIRSE Anatomy ....................................................... 365 Key Collateral Pathways ....................................... 366 Imaging ....................................................... 368 Acute Deep Vein Thrombosis .................................... 370 Chronic Venous Obstruction and Post-Phlebitic Syndrome ........ 374 Chronic Venous Valvular Insufficiency ......................... 375 Septic Thrombophlebitis ....................................... 381 Klippel-Trenaunay and Parkes-Weber Syndromes .................. 381 Venous Malformations .......................................... 382 Venous Aneurysms .............................................. 382 Suggested Readings ............................................ 385 Chapter 17 Image-Guided Percutaneous Biopsy .............................. 386 Michael J. Lee, MSc, FRQPI, FRCR, FFR(RCSI), FSIR, EBIR Patient Preparation ........................................ 386 Biopsy Technique .............................................. 386 Needle Choice ................................................. 386 Image Guidance ................................................ 387 Sonography .................................................... 388 Computed Tomography ........................................... 388 Performing the Biopsy ......................................... 389 Coaxial vs. Tandem Technique .................................. 389 Abdominal Biopsy .............................................. 390 Liver ......................................................... 390 Pancreas ...................................................... 391 Kidney ........................................................ 391 Adrenal Glands ................................................ 391 Retroperitoneum ............................................... 392 Prostate ...................................................... 392 Special Considerations ........................................ 394 Aftercare ..................................................... 395 Complications of Abdominal Biopsy ............................. 395 Abdominal Biopsy Results ...................................... 395 Lung and Mediastinal Biopsy ................................... 395 Technique ..................................................... 396 Image Guidance ................................................ 396 Needle Choice ................................................. 396 Performing the Biopsy ......................................... 397 Mediastinal Biopsy ............................................ 398 Aftercare and Complications ................................... 398 Results ....................................................... 399 Neck Biopsy ................................................... 399 Suggested Readings ............................................ 400 Chapter 18 Percutaneous Abscess and Fluid Drainage ....................... 401 Michael J. Lee, MSc, FRCPI, FRCR, FFR(RCSI), FSIR, EBIR Abdominal Fluid Collections ................................... 401 Patient Preparation ........................................... 401 Detection and Localization .................................... 401 Technique ..................................................... 401 Image Guidance ................................................ 402 Diagnostic Fluid Aspiration ................................... 402 Drainage Procedure ............................................ 402 Aftercare ..................................................... 404 Specific Abscess Drainages .................................... 405 Pancreatic Collections ........................................ 411 Pelvic Abscess ................................................ 414 Special Considerations ........................................ 415 Complications ................................................. 417 Thoracic Fluid Collections .................................... 418 Pleural Fluid Collections ..................................... 418 Diagnostic Thoracentesis ...................................... 418 Pleural Biopsy ................................................ 419 Therapeutic Thoracentesis ..................................... 422 Pleurodesis ................................................... 422 Empyema Drainage .............................................. 422 Results ....................................................... 423 Complications ................................................. 423 Lung and Mediastinal Abscesses ................................ 424 Suggested Readings ............................................ 424 Chapter 19 Gastrointestinal Tract Intervention ........................... 425 Michael J. Lee, MSc, FRCPI, FRCR, FFR(RCSI), FSIR, EBIR Percutaneous Gastrostomy ...................................... 425 Indications ................................................... 425 Contraindications ............................................. 425 Technique ..................................................... 425 Gastropexy .................................................... 426 Gastrostomy Tube Placement .................................... 426 Aftercare ..................................................... 427 Special Considerations ........................................ 428 Computed Tomography Guidance .................................. 428 The Postoperative Stomach ..................................... 429 Results ....................................................... 429 Complications ................................................. 430 New Departures in Percutaneous Gastrostomy .................... 431 Placement of Endoscopic Catheters ............................. 431 Primary Button Gastrostomy Placement .......................... 431 Percutaneous Gastrojejunostomy ................................ 432 Technique ..................................................... 432 Results and Complications ..................................... 434 Conversion of Percutaneous Gastrostomy to Gastrojejunostomy ... 434 Radiologic Gastrostomy Tube Conversion ........................ 434 Endoscopic Gastrostomy Tube Conversion ........................ 435 Surgical Conversion to Percutaneous Gastrojejunostomy ......... 435 Results ....................................................... 436 Comparison of Percutaneous, Endoscopic, and Surgical Gastrostomy ................................................ 436 Direct Percutaneous Jejunostomy ............................... 436 Technique ..................................................... 436 Results and Complications ..................................... 437 Percutaneous Cecostomy ........................................ 437 Indications ................................................... 437 Technique ..................................................... 437 Cecopexy ...................................................... 437 Cecostomy Catheter Insertion .................................. 437 Aftercare ..................................................... 437 Results ....................................................... 437 Complications ................................................. 437 Radiologic Management of Gastrointestinal Tract Strictures .... 437 Benign Gastrointestinal Strictures ............................ 437 Malignant Gastrointestinal Strictures (Metallic Stent Placement) ................................................. 441 Malignant Tracheoesophageal Fistulas .......................... 441 Colorectal Cancer ............................................. 447 Suggested Readings ............................................ 449 Chapter 20 Biliary Intervention .......................................... 451 Michael J. Lee, MSc, FRCPI, FRCR, FFR(RCSI), FSIR, EBIR Intrahepatic Ductal Anatomy ................................... 451 Patient Preparation ........................................... 451 Percutaneous Transhepatic Cholangiography ..................... 452 Technique ..................................................... 452 Results and Complications ..................................... 453 Biliary Drainage .............................................. 453 Preprocedure Imaging .......................................... 454 Right-Sided Biliary Drainage .................................. 454 Left-Sided Biliary Drainage ................................... 455 Palliation of Malignant Biliary Obstruction with Metal Stents ..................................................... 457 Hilar Obstruction ............................................. 457 Low Common Bile Duct Obstruction .............................. 460 Aftercare ..................................................... 460 Results ....................................................... 460 Complications ................................................. 462 Special Considerations ........................................ 465 Tissue Diagnosis of Malignant Biliary Obstruction ............. 466 Percutaneous Biliary Drainage After Failed Endoscopic Retrograde Cholangiopancreatography ........................ 467 Interventional Management of Laparoscopic Cholecystectomy Complications ................................. 467 Reintervention for Metal Stent Occlusion ...................... 467 Percutaneous Management of Benign Biliary Stricture ........... 469 Indications ................................................... 469 Preprocedure Evaluation ....................................... 469 Technique ..................................................... 469 Biliary Access ................................................ 469 Performing the Dilatation ..................................... 469 Metallic Stents for Benign Biliary Stricture .................. 471 Results ....................................................... 471 Percutaneous Management of Common Bile Duct Stones ............ 471 Percutaneous Extraction of Common Bile Duct Stones Through T-Tube Tract ............................................... 472 Suggested Readings ............................................ 473 Chapter 21 Gallbladder Intervention ...................................... 474 Michael J. Lee, MSc, FRCPI, FRCR, FFR(RCSI), FSIR, EBIR Diagnostic Gallbladder Intervention ........................... 474 Gallbladder Aspiration ........................................ 474 Diagnostic Cholecystocholangiography .......................... 474 Gallbladder Biopsy ............................................ 474 Therapeutic Gallbladder Intervention: Percutaneous Cholecystostomy ............................................ 474 Technique ..................................................... 475 Results ....................................................... 477 Catheter Care ................................................. 477 Complications ................................................. 477 Patient Outcomes .............................................. 477 Treatment of Gallbladder Perforation and Bile Leakage ......... 480 Nonsurgical Gallstone Therapies ............................... 480 Percutaneous Cholecystolithotomy .............................. 480 Gallbladder Ablation .......................................... 480 Suggested Reading ............................................. 483 Chapter 22 Percutaneous Genitourinary Intervention ....................... 485 Michael J. Lee, MSc, FRCPI, FRCR, FFR(RCSI), FSIR, EBIR Anatomy Relevant to Percutaneous Genitourinary Intervention .................................... 485 Kidney ........................................................ 485 Ureter ........................................................ 487 Bladder ....................................................... 487 Patient Preparation ........................................... 487 Renal Intervention ............................................ 487 Antegrade Pyelography ......................................... 487 Technique ..................................................... 488 Complications ................................................. 488 Whittaker Test ................................................ 488 Percutaneous Nephrostomy ...................................... 488 Technique ..................................................... 488 Aftercare ..................................................... 491 Results ....................................................... 491 Complications ................................................. 491 Special Circumstances ......................................... 492 Percutaneous Lithotripsy and Nephrolithotomy .................. 495 Technique ..................................................... 495 Results ....................................................... 498 Complications ................................................. 498 Percutaneous Stent Extraction ................................. 499 Ureteric Intervention ......................................... 499 Antegrade Stent Placement ..................................... 499 Technique ..................................................... 499 Commonly Encountered Problems ................................. 501 Results ....................................................... 505 Complications ................................................. 506 Balloon Dilatation of Ureteric Strictures ..................... 506 Ureteral Occlusion ............................................ 506 Endopyelotomy ................................................. 506 Bladder Intervention .......................................... 506 Suprapubic Cystostomy ......................................... 506 Indication .................................................... 506 Technique ..................................................... 506 Results ....................................................... 508 Complications ................................................. 508 Suggested Readings ............................................ 510 Chapter 23 Image-Guided Breast Intervention .............................. 511 Niamh Hambly, MBBChBAO, MRCPI, FFR(RCSI) Image-Guided Breast Biopsy .................................... 511 Indications ................................................... 511 Contraindications ............................................. 511 Complications ................................................. 511 General Principles ............................................ 512 Automated Spring Loaded Core Biopsy Devices ................... 513 Vacuum-Assisted Biopsy Devices ................................ 513 Breast Biopsy Reports ......................................... 514 Selection of Imaging Modality ................................. 514 Ultrasound-Guided Biopsy ...................................... 514 Stereotactic-Guided Biopsy .................................... 515 Magnetic Resonance Imaging-Guided Biopsy ...................... 518 Breast Lesion Excision Systems ................................ 521 Breast Lesion Excision System ................................. 522 Contraindications ............................................. 522 Complications ................................................. 522 Axillary Lymph Node Sampling .................................. 522 Axillary Fine-Needle Aspiration ............................... 523 Technique ..................................................... 523 Wire-Guided Localization ...................................... 523 Selection of Image Modality ................................... 523 Needles ....................................................... 523 Technique ..................................................... 524 Suggested Readings ............................................ 526 Chapter 24 Musculoskeletal Intervention .................................. 527 Farah C. Irani, MD, Xavier Buy, MD, and Afshin Gangi, MD, PhD Image Guidance ................................................ 527 Biopsies of the Musculoskeletal System ........................ 528 Indications ................................................... 528 Contraindications ............................................. 528 Tools ......................................................... 528 Technique ..................................................... 528 Complications ................................................. 529 Results ....................................................... 529 Facet Joint Infiltration ...................................... 530 Indications ................................................... 530 Technique ..................................................... 530 Complications ................................................. 530 Results ....................................................... 530 Rhyzolysis: Radiofrequency Neurotomy of the Zygapophysial Joints ..................................................... 531 Indication .................................................... 531 Technique ..................................................... 531 Complications ................................................. 531 Results ....................................................... 531 Percutaneous Epidural and Nerve Root Block .................... 532 Indications ................................................... 532 Contraindications ............................................. 532 Technique ..................................................... 532 Lumbar Infiltrations .......................................... 532 Epidural Lateral Infiltration ................................. 532 Foraminal Infiltration ........................................ 532 Cervical Infiltration ......................................... 532 Postprocedure Care ............................................ 533 Complications ................................................. 533 Results ....................................................... 533 Percutaneous Disc Decompression ............................... 533 Indications ................................................... 534 Contraindications ............................................. 534 Percutaneous Laser Disc Decompression ......................... 534 Material ...................................................... 534 Technique ..................................................... 534 Postoperative Care ............................................ 534 Complications ................................................. 534 Results ....................................................... 535 Bipolar Radiofrequency Nucleoplasty ........................... 535 Technique ..................................................... 535 Lumbar Level .................................................. 535 Thoracic Level ................................................ 536 Cervical Level ................................................ 536 Postoperative Instructions .................................... 536 Complications ................................................. 536 Results ....................................................... 536 Conclusion .................................................... 536 Targeted Disc Decompression ................................... 536 Thermal Ablation of Bone Tumors ............................... 537 Percutaneous Alcohol Ablation of Bone Metastases .............. 537 Percutaneous Radiofrequency Ablation and Cryoablation ......... 537 Indications ................................................... 537 Technique ..................................................... 538 Results ....................................................... 539 Percutaneous Vertebroplasty ................................... 539 Indications ................................................... 539 Absolute Contraindications .................................... 540 Relative Contraindications .................................... 540 Patient Selection ............................................. 540 Imaging ....................................................... 540 Procedure ..................................................... 541 Biplane Fluoroscopy ........................................... 541 Dual Guidance ................................................. 541 Cement Injection .............................................. 541 Postprocedural Care ........................................... 541 Complications ................................................. 541 Results ....................................................... 542 Kyphoplasty ................................................... 542 Indications ................................................... 542 Contraindications ............................................. 542 Preprocedure Imaging .......................................... 542 Technique ..................................................... 542 Calcium Phosphate Cements ..................................... 542 Postprocedural Care ........................................... 543 Complications ................................................. 543 Results ....................................................... 543 Osteoid Osteoma ............................................... 543 Indication .................................................... 544 Contraindications ............................................. 544 Technique ..................................................... 544 Complications ................................................. 544 Results ....................................................... 544 Suggested Readings ............................................ 544 Chapter 25 Image-Guided Tumor Ablation: Basic Principles ................. 547 Michael D. Beland, MD, and William W. Mayo-Smith, MD, FACR Methods of Ablation ........................................... 547 Chemical Ablation ............................................. 547 Radiqfrequency Ablation ....................................... 547 Cryoablation .................................................. 549 Microieeroe Ablation .......................................... 549 Interstitial Laser Photocoagulation ........................... 550 High-Intensity Focused Ultrasound ............................. 550 Performing Ablation ........................................... 550 Patient Preparation ........................................... 550 Imaging Guidance .............................................. 550 Postprocedural Follow-Up and Imaging .......................... 552 Future Directions ............................................. 553 Suggested Readings ............................................ 553 Chapter 26 Image-Guided Ablation of Renal Tumors ......................... 554 Colin P. Cantwell, FRCR, FFR, and Debra A. Gervais, MD Methods of Ablation ........................................... 554 Indications and Outcome ....................................... 554 Image-Guided Ablation for Renal Cell Cancer ................... 554 Image-Guided Ablation of Benign Renal Masses .................. 555 Image-Guided Ablation for Symptomatic Palliation .............. 555 Ablation Planning and Procedure ............................... 555 Preablation Evaluation and Treatment Planning ................. 555 Biopsy ........................................................ 556 Procedure ..................................................... 556 Targeting, Controlling, and Monitoring Therapy ................ 556 Size and Geometry of Ablation Zone in Renal Tissue ............ 557 Adjunctive Techniques to Protect Organs ....................... 557 Pyeloperfusion Technique ...................................... 557 Displacement Techniques ....................................... 558 Postprocedure Care ............................................ 558 Post-Radiofrequency Ablation Syndrome ......................... 558 Complications ................................................. 558 Outcomes and Follow-Up ........................................ 559 Imaging Assessment of Treatment Response ...................... 559 Renal Function ................................................ 559 Suggested Readings ............................................ 560 Chapter 27 Image-Guided Ablation as a Treatment Option for Thoracic Malignancies .................................................. 562 Alice M. Kim, MD, and Damian E. Dupuy, MD, FACR Radiofrequency Ablation ....................................... 562 Patient Evaluation ............................................ 562 Technique ..................................................... 563 Complications ................................................. 563 Imaging Follow-Up ............................................. 564 Radiofrequency Ablation in Primary Versus Secondary Lung Tumors ..................................................... 565 Microwave Ablation ............................................ 568 Cryoablation .................................................. 570 Conclusion .................................................... 570 Suggested Readings ............................................ 570 Chapter 28 Image-Guided Ablation of Liver Tumors ......................... 572 Colin P. Cantwell, FRCR, FFR, and Debra A. Gervais, MD Methods of Ablation ........................................... 572 Indications and Outcomes ...................................... 572 Image-Guided Ablation for Hepatocellular Carcinoma ............ 572 Image-Guided Ablation for Hepatic Colorectal Carcinoma Metastasis ................................................. 573 Image-Guided Ablation for Other Hepatic Metastases and Tumors ..................................................... 573 Ablation Planning and Procedure ............................... 574 Preablation Evaluation and Treatment Planning ................. 574 Biopsy ........................................................ 574 Procedure ..................................................... 574 Targeting, Controlling, and Monitoring Therapy ................ 574 Size and Geometry of Ablation ................................. 576 Adjunctive Techniques to Protect Organs ....................... 577 Adjuvant Therapies ............................................ 577 Postprocedure Care ............................................ 577 Complications ................................................. 578 Follow-Up ..................................................... 578 Markers ....................................................... 578 Imaging Assessment of Treatment Response ...................... 578 Suggested Readings ............................................ 579