More articles from Spine Imaging and Spine Image-Guided Interventions

This is a retrospective study of imaging-guided spine cryoablation that was performed on 31 vertebral metastases in 14 patients. The lesions were refractory to conventional chemoradiation therapy or analgesics and were ablated to achieve pain palliation and local tumor control. The procedures were performed with the patient under conscious sedation (13 patients) or general anesthesia in 1 case. Postcryoablation MR imaging and PET/CT imaging were available for all patients. Spinal nerve and soft-tissue thermal protection techniques were implemented in all ablations (epidural or neuroforaminal carbon dioxide or warmed 5% dextrose). There were statistically significant decreases in the median numeric pain rating scale score and analgesic usage at 1-week, 1-month, and 3-month time points. Local tumor control was achieved in 96.7% (30/31) of tumors.

CTA images of the arterial and late arterial phases were used to obtain warped images of the late arterial phase by nonrigid registration that was adjusted to the arterial phase images. R-CTA images were then obtained by subtracting the warped images from the arterial phase images. R-CTA had a higher accuracy compared with conventional spinal CTA (80% versus 47%). The authors conclude that subtracted CTA imaging using nonrigid registration detects feeders of spinal arteriovenous fistulas more accurately and quickly than conventional CTA.