Publications by authors named "Alexis Kelekis"

58 Publications

Percutaneous Microwave Ablation of Liver Lesions: Differences on the Sphericity Index of the Ablation Zone between Cirrhotic and Healthy Liver Parenchyma.

Diagnostics (Basel) 2021 Apr 5;11(4). Epub 2021 Apr 5.

2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 15122 Athens, Greece.

To compare different parameters of the sphericity index of the ablation zone following microwave ablation (MWA) on cirrhotic- and healthy-liver parenchyma in a series of patients treated with the same MWA system. Institutional database research identified 46 patients (77 lesions) who underwent MWA. "Cirrhotic liver group" (CLG) included 35 hepatocellular carcinoma lesions; "healthy liver group" (HLG) included 42 metastatic lesions. The long axis (LAD), short axis 1 (SAD-1) and 2 (SAD-2), the mean SAD-1 and SAD-2 (mSAD) diameter (in mm) and the mean sphericity (mSPH) index of the ablation zones were evaluated for each treated lesion in both groups from baseline to follow-up. A mixed model analysis of variance reported significant main effect of group on SAD-1 ( = 0.023), SAD-2 ( = 0.010) and mSAD ( = 0.010), with HLG showing lower values compared to CLG. No differences were detected on the LAD (p = 0.089; d = 0.45), and mSPH (p = 0.148, d = 0.40) between the two groups. However, a significant main effect of time was found on LAD ( < 0.001), SAD-1 ( < 0.001), SAD-2 ( < 0.001) and mSAD ( < 0.001), with decreased values in all indices at follow-up compared to baseline. A significant group by time interaction was observed on mSPH ( = 0.044); HLG had significantly lower mSPH at follow-up where CLG did not show any significant change. Our findings indicate that although in cirrhotic liver short axis diameter of the MWA zone seems to be significantly longer, this has no effect on the sphericity index which showed no significant difference between cirrhotic vs. healthy liver lesions. On the contrary, on one month follow-up ablation zones tend to become significant more ellipsoid in healthy whilst remains stable in cirrhotic liver.
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http://dx.doi.org/10.3390/diagnostics11040655DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066372PMC
April 2021

Long-term outcome of bilateral sciatic nerve palsy due to unrecognized thigh compartment syndrome.

Acta Neurol Belg 2021 Apr 7. Epub 2021 Apr 7.

Department of Neurology, Medical School, University of Patras, 26504, Rio, Patras, Greece.

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http://dx.doi.org/10.1007/s13760-021-01669-3DOI Listing
April 2021

Percutaneous bipolar radiofrequency ablation for spine metastatic lesions.

Eur J Orthop Surg Traumatol 2021 Mar 30. Epub 2021 Mar 30.

2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Athens, Greece.

Purpose: The purpose of this review is to become familiar with the most common indications for imaging guided percutaneous bipolar radiofrequency ablation, to learn about different technical considerations during performance providing the current evidence. Controversies concerning products will be addressed.

Methods: We performed a literature review excluding non-English studies and case reports. All references of the obtained articles were also evaluated for any additional information.

Results: RFA achieves cytotoxicity by raising target area temperatures above 60 °C, and may be used to achieve total necrosis of lesions smaller than 3 cm in diameter, to debulk and reduce the pain associated with larger lesions, to prevent pathological fractures due to progressive osteolysis or for cavity creation aiming for targeted cement delivery in case of posterior vertebral wall breaching. Protective ancillary techniques should be used in order to increase safety and augment efficacy of RFA in the spine.

Conclusion: Percutaneous radiofrequency ablation of vertebral lesions is a reproducible, successful and safe procedure. Ablation should be combined with vertebral augmentation in all cases. In order to optimize maximum efficacy a patient- and a lesion-tailored approach should both be offered focusing upon clinical and performance status along with life expectancy of the patient as well as upon lesion characteristics.
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http://dx.doi.org/10.1007/s00590-021-02947-9DOI Listing
March 2021

A bicentric propensity score matching study comparing percutaneous computed tomography-guided radiofrequency Ablation to Magnetic Resonance-guided Focused Ultrasounds for the treatment of osteoid osteoma.

J Vasc Interv Radiol 2021 Mar 25. Epub 2021 Mar 25.

2nd Department of Radiology, University General Hospital "ATTIKON" Athens, Greece.

Purpose: To assess safety and efficacy of CT-guided radio frequency ablation (RFA) and Magnetic Resonance guided Focused Ultrasounds (MRgFUS) in the treatment of osteoid osteoma with a long-term follow-up study (mean follow-up time longer than 2 years).

Materials And Methods: Database research was carried out in two different centres with experience in musculoskeletal interventions. Both centres, one performing RFA, the other MRgFUS, identified 116 patients, who were submitted to either RFA or MRgFUS for the treatment of symptomatic osteoid osteoma and retrospectively evaluated data regarding pain scores (using a visual analogue scale). Complications were recorded according to the CIRSE classification system. Propensity score matching for multiple variables was performed. Pre- and post-therapy pain scores were compared.

Results: Out of the 116 patients treated, 61 underwent RFA and 55 MRgFUS. The mean values of pre-treatment pain in the two groups were 9.1±0.88 (RFA) and 8.7±0.73 (MRgFUS) VAS units. Post- treatment statistically significant (p<0.00001) overall reduction in pain symptomatology was recorded. No statistically significant difference was observed between the post-treatment mean values of both groups (p=0.256). Four cases of relapse (1 RFA; 3 MRgFUS) and one complication (RFA) were observed. The analysis from propensity score matching that identified a matched cohort of 48 patients showed similar results.

Conclusions: Both techniques for the treatment of osteoid osteoma seem to ensure a similar pain relief. The presence of thick cortical bone over the nidus can of reduce the effectiveness of MRgFUS.
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http://dx.doi.org/10.1016/j.jvir.2021.03.528DOI Listing
March 2021

Feasibility and safety of percutaneous computed tomography guided radiofrequency ablation of lymph nodes in oligometastatic patients: a single center's experience.

Br J Radiol 2021 May 23;94(1121):20200445. Epub 2021 Mar 23.

Diagnostic and Interventional Radiology 2nd Radiology Dpt, University General Hospital "ATTIKON" Medical School, National and Kapodistrian University of Athens 1 Rimini str, 12462, Haidari/Athens, Greece.

Objectives: To retrospectively evaluate feasibility and safety of CT-guided percutaneous radiofrequency ablation (RFA) of metastatic lymph nodes (LN) in terms of achieving local tumor control.

Methods: Institutional database research identified 16 patients with 24 metastatic LNs who underwent percutaneous CT-guided radiofrequency ablation. Mean patient age was 66.6 ± 15.70 years (range 40-87) and male/female ratio was 8/8. Contrast-enhanced CT or MRI was used for post-ablation follow-up. Patient and tumor characteristics and RFA technique were evaluated. Technical and clinical success on per tumor and per patient basis as well as complication rates were recorded.

Results: Mean size of the treated nodes was 1.78 ± 0.83 cm. The mean number of tumors per patient was 1.5 ± 0.63. The mean procedure time was 56.29 ± 24.27 min including local anesthesia, electrode(s) placement, ablation and post-procedural CT evaluation. Median length of hospital stay was 1.13 ± 0.34 days. On a per lesion basis, the overall complete response post-ablation according to the mRECIST criteria applied was 75% (18/24) of evaluable tumors. Repeat treatment of an index tumor was performed on two patients (three lesions) with complete response achieved in 87.5% (21/24) of evaluable tumors following a second RFA. On a per patient basis, disease progression was noted in 10/16 patients at a mean of 13.9 ± 6.03 months post the ablation procedure.

Conclusion: CT-guided percutaneous RFA for oligometastatic LNs is a safe and feasible therapy.

Advances In Knowledge: With this percutaneous therapeutic option, metastatic LNs can be eradicated with a very low complication rate.
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http://dx.doi.org/10.1259/bjr.20200445DOI Listing
May 2021

Percutaneous Microwave Ablation and Osteoplasty of an Aneurysmal Bone Cyst.

J Vasc Interv Radiol 2021 Mar 6. Epub 2021 Mar 6.

Second Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, 'Attikon' University General Hospital, Athens, Greece.

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http://dx.doi.org/10.1016/j.jvir.2021.02.015DOI Listing
March 2021

The Role of Percutaneous Ablation in the Management of Colorectal Cancer Liver Metastatic Disease.

Diagnostics (Basel) 2021 Feb 14;11(2). Epub 2021 Feb 14.

Memorial Sloan Kettering Cancer Center, Weill-Cornell Medical College, New York, NY 10065, USA.

Approximately 50% of colorectal cancer patients will develop metastases during the course of the disease. Local or locoregional therapies for the treatment of liver metastases are used in the management of oligometastatic colorectal liver disease, especially in nonsurgical candidates. Thermal ablation (TA) is recommended in the treatment of limited liver metastases as free-standing therapy or in combination with surgery as long as all visible disease can be eradicated. Percutaneous TA has been proven as a safe and efficacious therapy offering sustained local tumor control and improved patient survival. Continuous technological advances in diagnostic imaging and guidance tools, the evolution of devices allowing for optimization of ablation parameters, as well as the ability to perform margin assessment have improved the efficacy of ablation. This allows resectable small volume diseases to be cured with percutaneous ablation. The ongoing detailed information and increasing understanding of tumor biology, genetics, and tissue biomarkers that impact oncologic outcomes as well as their implications on the results of ablation have further allowed for treatment customization and improved oncologic outcomes even in those with more aggressive tumor biology. The purpose of this review is to present the most common indications for image-guided percutaneous ablation in colorectal cancer liver metastases, to describe technical considerations, and to discuss relevant peer-reviewed evidence on this topic. The growing role of imaging and image-guidance as well as controversies regarding several devices are addressed.
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http://dx.doi.org/10.3390/diagnostics11020308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918461PMC
February 2021

Computed Tomography-Guided Percutaneous Radiofrequency Ablation of the Splanchnic Nerves as a Single Treatment for Pain Reduction in Patients with Pancreatic Cancer.

Diagnostics (Basel) 2021 Feb 13;11(2). Epub 2021 Feb 13.

2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 12462 Athens, Greece.

The aim of this paper is to prospectively evaluate the efficacy and safety of percutaneous computed tomography (CT)-guided radiofrequency (RF) neurolysis of splanchnic nerves as a single treatment for pain reduction in patients with pancreatic cancer. Patients with pancreatic ductal adenocarcinoma suffering from abdominal pain refractory to conservative medication who underwent CT-guided neurolysis of splanchnic nerves by means of continuous radiofrequency were prospectively evaluated for pain and analgesics reduction as well as for survival. In all patients, percutaneous neurolysis was performed with a bilateral retrocrural paravertebral approach at T12 level using a 20 Gauge RF blunt curved cannula with a 1cm active tip electrode. Self-reported pain scores were assessed before and at the last follow-up using a pain inventory with numeric visual scale (NVS) units. The mean patient age was 65.4 ± 10.8 years (male-female: 19-11). The mean pain score prior to RF neurolysis of splanchnic nerves was 9.0 NVS units; this score was reduced to 2.9, 3.1, 3.6, 3.8, and 3.9 NVS units at 1 week, 1, 3, 6, and 12 months respectively ( < 0.001). Significantly reduced analgesic usage was reported in 28/30 patients. Two grade I complications were reported according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system. According to the results of the present study, solely performed computed tomography-guided radiofrequency neurolysis of splanchnic nerves can be considered a safe and efficacious single-session technique for pain palliation in patients with pancreatic ductal adenocarcinoma suffering from abdominal pain refractory to conservative medication. Although effective in pain reduction the technique seems to have no effect upon survival improvement.
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http://dx.doi.org/10.3390/diagnostics11020303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917944PMC
February 2021

Continuous versus pulsed microwave ablation in the liver: any difference in intraoperative pain scores?

Ann Gastroenterol 2021 20;34(1):80-84. Epub 2020 Nov 20.

2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis).

Background: This study prospectively compared intraoperative pain scores during percutaneous microwave ablation of the liver in patients randomized between continuous and pulsed energy delivery algorithms.

Methods: During a 12-month period, 20 patients who underwent microwave liver ablation were prospectively randomized between 2 different energy delivery modes: "continuous mode" (CM, n=10) and "pulsed mode" (PM, n=10). All ablation sessions were performed using the same microwave ablation platform under computed tomographic guidance and intravenous analgesia. Within 30 min post ablation, all patients completed a questionnaire assigning a numeric pain intensity score from 0 (no pain) to 10.

Results: Mean pain scores were 8.17±1.850 in the CM group and 4.50±1.567 in the PM group, with a statistically significant difference of 3.667±2.807 pain units (P=0.001). The mean procedure time was 53.5±20.90 min in the PM group vs. 58.5±17.44 min in the CM group (P=0.279). The mean size of the lesions was 2.81±0.95 cm in the PM group and 2.81±0.85 cm in the CM group (P=0.984). On a per-lesion basis, technical success was achieved in all evaluable tumors in both groups. No difference was noted in the local tumor control on the 6-month imaging evaluation. No complications were observed in the CM arm, while small perihepatic hemorrhagic fluid collections were reported in the PM group.

Conclusions: Both algorithms for microwave energy delivery have comparable treatment effects in terms of 6-month local tumor control for liver lesions <3 cm in diameter. PM treatments compared to CM appear to induce significantly less pain in patients undergoing percutaneous liver ablation under intravenous analgesia.
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http://dx.doi.org/10.20524/aog.2020.0557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774668PMC
November 2020

Preliminary Data of a Quantitative Point of Care Test for SARS-CoV-2 Antibodies From Greece.

In Vivo 2020 Sep-Oct;34(5):3039-3045

Second Department of Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece

Background: Antibody testing is necessary to identify immune individuals in the post-initial wave of the COVID-19 pandemic.

Patients And Methods: We prospectively evaluated the performance of a quantitative point-of-care test (POCT) for SARS-CoV-2 antibodies. The patient group (PG) comprised of hospitalized confirmed COVID-19 cases. Asymptomatic healthcare volunteers with negative rRT-PCR were included in the control group (CG). Measurement of IgM and IgG was obtained by dry fluorescence immunoassay.

Results: Twenty-six PG (65.9±15.4 years old, male 57.7%) and 18 CG (45.6±10.1 years old, male 33.3%) were included. By manufacturer's cut-off (≥0.04 mIU/ml), sensitivity and specificity were 73.08% and 88.89% for IgM and 88.46% and 33.33% for IgG, respectively. Estimated areas under the ROC curve were 0.907 and 0.848 for IgM and IgG, respectively. Results were improved using a cut-off of IgM ≥0.05 mIU/ml and IgG ≥0.10 mIU/ml.

Conclusion: Using stringent cut-off values, SARS-CoV-2 antibody POCT detects immune people and can be used during socioeconomic normalization of communities.
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http://dx.doi.org/10.21873/invivo.12138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652506PMC
September 2020

Computed Tomography-Guided Radiofrequency Thermocoagulation of the Gasserian Ganglion Using an Alternative to Hartel Anterior Approach: A Bicentral Study.

Pain Physician 2020 06;23(3):293-298

Department of Interventional Radiology, Athens Naval Hospital, Athens, Greece.

Background: Trigeminal neuralgia (TN) is associated with multiple mechanisms involving peripheral and central nervous system pathologies. Among percutaneous treatments offered, radiofrequency thermocoagulation (RFT) is associated with longer duration of pain relief. Mostly due to anatomic variation, cannulation of the foramen ovale using the Hartel approach has a failure rate of 5.17%.

Objectives: To report safety and efficacy of continuous RFT with an alternative to Hartel anterior approach under computed tomography (CT) guidance in patients with classic TN.

Study Design: Retrospective institutional database review; bicentral study.

Setting: Although this was a retrospective database research, institutional review board approval was obtained.

Methods: Institutional database review identified 10 patients (men 8, women 2) who underwent CT-guided RFT of the Gasserian ganglion. Preoperational evaluation included physical examination and magnetic resonance imaging. Under anesthesiology control and local sterility measures, a radiofrequency needle was advanced, and its approach was evaluated with sequential CT scans. Motor and sensory electrostimulation tests evaluated correct electrode location. Pain prior, 1 week, 1, 3, and 6 months after were compared by means of a numeric visual scale (NVS) questionnaire.

Results: Mean self-reported pain NVS score prior to RFT was 9.2 ± 0.919 units. One week after the RFT mean NVS score was 1.10 ± 1.287 units (pain reduction mean value of 8.1 units). At 3 and 6 months after thermocoagulation the mean NVS score was 2.80 ± 1.549 units and 2.90 ± 1.370 units, respectively. There were no postoperative complications. Three patients experienced facial numbness, which gradually resolved over a period of 1 month.

Limitations: Retrospective nature; small number of patients; lack of a control group undergoing a different treatment of TN.

Conclusions: Percutaneous CT-guided RFT of the Gasserian ganglion constitutes a safe and efficacious technique for the treatment of TN, with significant pain relief and minimal complication rates improving life quality in this group of patients.

Key Words: Trigeminal nerve, neuralgia, pain, radiofrequency, ablation, percutaneous, computed tomography, imaging.
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June 2020

Percutaneous Management of Cancer Pain.

Curr Oncol Rep 2020 04 16;22(5):43. Epub 2020 Apr 16.

Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Purpose Of Review: To describe several effective imaging-guided, minimally invasive treatments to relieve cancer-associated pain in oncologic patients. Clinical applications, technical considerations, and current controversies are addressed.

Recent Findings: The great variability in tumor subtype, location, and growth rates dictate the necessity for a tailored treatment approach. While opioids and radiotherapy may provide adequate relief for some patients, alternative minimally invasive procedures may augment theses more traditional treatments or even provide superior palliative relief. Recent image-guided percutaneous techniques applied to reduce cancer-associated pain and minimize opioid dependence include neurolysis, ablation, high intensity focused ultrasound, and bone consolidation. Each technique treats cancer pain in a unique method. Minimally invasive interventional radiology techniques can provide effective and lasting pain palliation for cancer patients through both indirect and direct effects. Selection among treatments techniques should be based upon an individually tailored approach, to include consideration of all treatment modalities.
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http://dx.doi.org/10.1007/s11912-020-00906-xDOI Listing
April 2020

Rare aneurysmal bone cysts: multifocal, extraosseous, and surface variants.

Eur J Orthop Surg Traumatol 2020 Aug 27;30(6):969-978. Epub 2020 Feb 27.

Department of Orthopaedics and Orthopaedic Oncology, University of Padova, Padua, Italy.

Multifocal, extraosseous, and surface aneurysmal bone cysts are rare variants of the primary lesions. The clinicopathological features are similar, and the optimal treatment is surgical. Although local recurrences may occur, the prognosis is excellent. This review article introduces the readers to a rare diagnosis which they may have been previously unfamiliar with, presents the clinicopathological and imaging features of these rare aneurysmal bone cyst variants, and discusses their diagnosis and treatment. The clinicians who treat patients with aneurysmal bone cysts should be familiar with these uncommon entities and their differential diagnosis.
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http://dx.doi.org/10.1007/s00590-020-02640-3DOI Listing
August 2020

Safety and efficacy of percutaneous microwave ablation for post-procedural haemostasis: a bi-central retrospective study focusing on safety and efficacy.

Br J Radiol 2020 Feb 12;93(1106):20190615. Epub 2019 Dec 12.

2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece.

Objective: To review safety and efficacy of percutaneous microwave ablation (MWA) for post-procedural haemostasis.

Methods: Institutional databases retrospective research identified 10 cases of iatrogenic bleeding who underwent percutaneous MWA for post-procedural haemostasis. Ultrasound examination with Doppler and contrast enhancement identified a source of active bleeding prior to ablation; additionally they were used as guiding modality for antenna insertion whilst, post-ablation, assessed the lack of active extravasation. Target locations included liver intercostal space spleen and thyroid gland. Technical success was defined as positioning of the antenna on the desired location. Treatment end point was considered the disappearance of active extravasation in both Doppler imaging and contrast-enhanced ultrasound.

Results: Technical success ( positioning of the antenna on the desired location) was achieved in all cases. No complications were noted. All patients post MWA remained haemodynamically stable with no need for transfusion and were discharged from the hospital the next morning. Imaging and clinical follow-up in all patients before exiting the hospital did not depict any sign of active extravasation or bleeding.

Conclusion: Our limited experience reports preliminary data showing that MWA could be added in the armamentarium of percutaneous therapies for iatrogenic bleeding. More prospective studies with larger patient samples are necessary for verification of this technique as well as for drawing broader conclusions in order to evaluate the place of percutaneous ablation in the treatment algorithm of haemorrhage.

Advances In Knowledge: Percutaneous ablation might have a role in haemostasis in well-selected cases.
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http://dx.doi.org/10.1259/bjr.20190615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055444PMC
February 2020

The Role of Ablation in Cancer Pain Relief.

Curr Oncol Rep 2019 11 25;21(12):105. Epub 2019 Nov 25.

2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 1 Rimini str, 12462 Haidari, Athens, Greece.

Purpose Of Review: The purpose of this article is to describe the concepts of ablation techniques for pain relief in symptomatic oncologic patients. Controversies concerning techniques and products will be addressed.

Recent Findings: Despite conventional pain palliative techniques, cancer patients often endorse unresolved somatic and neuropathic pain that can present as a great burden to quality of life. In non-operative patients, several techniques have been applied to minimize opioid dependence. While radiotherapy is often considered as a non-invasive option, percutaneous ablation has been advanced as a minimally-invasive alternative with clear procedural and outcome advantages. Similar to radiation therapy, percutaneous ablation techniques can act either upon nerve structures responsible for pain mediation signals (neurolysis) or directly upon the tumor to relieve tumor-mediated inflammation and decompress tumor compression of adjacent structures. Percutaneous ablation provides valuable neurolysis and tumor-directed pain palliative effects to be incorporated into clinical guidelines for pain reduction in oncologic patients. Selection among different ablation techniques should be based upon an individually tailored approach, to include consideration of all treatment modalities.
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http://dx.doi.org/10.1007/s11912-019-0844-9DOI Listing
November 2019

Percutaneous management of metastatic osseous disease.

Chin Clin Oncol 2019 Dec 14;8(6):62. Epub 2019 Nov 14.

Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France.

Metastases to the bone represent the third most common site of metastatic disease. More than 50% of patients with metastatic cancer will develop bone metastases. Associated morbidity is related to local tumor progression that destroys bone to result in pain, pathologic fracture, hypercalcemia, and neurologic deficits. Depending on the tumor biology, systemic chemotherapy or radiation therapy may not provide complete local control and may not adequately relieve associated pain. While surgical intervention may be beneficial in many patients, surgical options may also provide incomplete locoregional cure or palliation, and moreover may require extensive healing that can delay systemic therapy. Interventional oncology treatments can provide appealing alternative therapies for osseous metastases. These minimally-invasive therapies can augment existing conventional treatments and even provide a viable option for patients that have exhausted, or are not suitable candidates, for conventional treatments. Interventional oncology treatments are applied for either pain palliation, local tumor control, or both. The goals of treatment can include tumor remission or cure, as well as improved quality of life and mobility. An effective and durable interventional oncology treatment requires a tailored approach that considers the high variability in disease presentation. Osseous metastases may present throughout the skeleton, with low to high vascularity, and undulant to rapidly aggressive tumor biology. This article reviews the main percutaneous treatment for osseous metastases that include embolization, thermal ablation, vertebral augmentation, cementoplasty, and fixation by internal cemented screw (FICS).
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http://dx.doi.org/10.21037/cco.2019.10.02DOI Listing
December 2019

Two-Center Prospective Comparison of the Trocar and Seldinger Techniques for Percutaneous Cholecystostomy.

AJR Am J Roentgenol 2020 01 1;214(1):206-212. Epub 2019 Oct 1.

2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.

The purpose of this study is to compare the safety and efficacy of the bedside ultrasound (US)-guided trocar technique versus the US- and fluoroscopy-guided Seldinger technique for percutaneous cholecystostomy (PC). This prospective noninferiority study compared the bedside US-guided trocar technique for PC (the trocar group; 53 patients [28 men and 25 women]; mean [± SD] age, 74.31 ± 16.19 years) with the US- and fluoroscopy-guided Seldinger technique for PC (the Seldinger group; 52 patients [26 men and 26 women], mean age, 79.92 ± 13.38 years) in consecutive patients undergoing PC at two large tertiary university hospitals. The primary endpoints were technical success and procedure-related complication rates. Secondary endpoints included procedural duration, pain assessment, and clinical success after up to 3 months of follow-up. PC was successfully performed for all 105 patients. The clinical success rate was similar between the two study groups (86.8% in the trocar group vs 76.9% in the Seldinger group; = 0.09). Mean procedural time was significantly lower in the trocar group than in the Seldinger group (1.77 ± 1.62 vs 4.88 ± 2.68 min; < 0.0001). Significantly more procedure-related complications were noted in the Seldinger group than in the trocar group (11.5% vs 1.9%; = 0.02). Among patients in the Seldinger group, bile leak occurred in 7.7%, abscess formation in 1.9%, and gallbladder rupture in 1.9%. No procedure-related death was noted. Minor bleeding occurred in one patient (1.9%) in the trocar group, but the bleeding resolved on its own. The mean pain score during the procedure was significantly lower in the Seldinger group than in the trocar group (3.2 ± 1.77 vs 4.76 ± 2.17; = 0.01). At 12 hours after the procedure, the mean pain score was significantly lower for patients in the trocar group (0.78 ± 1.0 vs 3.12 ± 1.36; = 0.0001). Use of the bedside US-guided trocar technique for PC was equally effective as the Seldinger technique but was associated with fewer procedure-related complications, required less procedural time, and resulted in decreased postprocedural pain, compared with fluoroscopically guided PC using the Seldinger technique.
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http://dx.doi.org/10.2214/AJR.19.21685DOI Listing
January 2020

Percutaneous Radiofrequency Ablation of an Auricular Lymphangioma.

J Vasc Interv Radiol 2019 Oct 22;30(10):1678-1679. Epub 2019 Aug 22.

Second Department of Radiology, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 12462 Haidari/Athens, Greece.

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http://dx.doi.org/10.1016/j.jvir.2019.04.013DOI Listing
October 2019

Percutaneous Neurolysis for Pain Management in Oncological Patients.

Cardiovasc Intervent Radiol 2019 Jun 19;42(6):791-799. Epub 2019 Feb 19.

Division of Interventional Radiology, Department of Radiology, University Hospital Waterford, Ardkeen, Waterford City, Ireland.

Cancer pain is most commonly classified as nociceptive (somatic or visceral) or neuropathic. Different types of pain or pain syndromes are present in all phases of cancer (early and metastatic) and are inadequately treated in 56% to 82.3% of patients. Percutaneous neurolysis and neuromodulation are feasible and reproducible, efficient (70-80% success rate) and safe (≈ 0.5% mean complication rate) palliative therapies for pain reduction in oncologic patients with refractory pain. Percutaneous neurolysis can be performed either by injection of a chemical agent (phenol or alcohol) or by application of continuous radiofrequency or cryoablation. During chemical neurolysis nerve damage is achieved by means of Wallerian degeneration. A thorough knowledge of neural anatomy and pain transmission pathways is fundamental to appropriate patient and technique selection. Imaging guidance and strict asepsis are prerequisites. The purpose of this article is to describe the basic concepts of percutaneous neurolysis in oncologic patients. Controversies concerning techniques and products will be addressed. Finally, the necessity for an individually tailored approach for the selection of the different techniques and targets will be emphasized.
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http://dx.doi.org/10.1007/s00270-019-02185-xDOI Listing
June 2019

Evaluation of pain reduction and height restoration post vertebral augmentation using a polyether ether ketone (PEEK) polymer implant for the treatment of split (Magerl A2) vertebral fractures: a prospective, long-term, non-randomized study.

Eur Radiol 2019 Aug 3;29(8):4050-4057. Epub 2018 Dec 3.

2nd Department of Radiology, Attikon General University Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari, 12462, Athens, Greece.

Objectives: The purposes of the study were to evaluate the safety and long-term efficacy of augmented vertebroplasty using a polyether ether ketone (PEEK) implant, for the treatment of lumbar or thoracic vertebral fractures (A2 according to the Magerl's AO classification) and to analyze pain reduction, height restoration, and complications during a 2-year follow-up period.

Methods: Prospective non-randomized evaluation was performed for 21 painful split vertebral fractures (20 patients, 14 females, 6 males; mean age 72.80 ± 10.991) treated with percutaneous vertebral augmentation using a PEEK device, under fluoroscopic guidance. Pain before the procedure and after 6, 12, and 24 months was evaluated using a numeric visual scale (NVS) questionnaire. Imaging was performed by CT and X-rays. The minimum craniocaudal diameter at the level of the fracture and the maximum craniocaudal diameter at the middle of the fractured vertebra were measured. Statistical analysis was performed to evaluate pain decrease and height restoration.

Results: Successful implant positioning was achieved in all cases. No major clinical complications were observed. Comparing the mean pain scores at baseline (8.69 ± 1.138) and the first day after the treatment (1.19 ± 1.424), there was a decrease of 7.50 NVS units (p < 0.001). Minimum and maximum vertebral body heights were increased after the procedure 56.58% and 13.7% respectively (p < 0.001). Both pain relief and height restoration remained statistically significant (p < 0.001) during the follow-up period.

Conclusion: A2 Magerl thoracic or lumbar fractures could be successfully treated with PEEK implant-assisted vertebral augmentation. Randomized studies with larger sample sizes should be done to confirm the effectiveness of the technique.

Key Points: • Vertebral augmentation using a PEEK implant for the treatment of A2 Magerl lumbar or thoracic vertebral fractures seems to be effective both in terms of pain reduction and height restoration. • Effects on pain reduction and height restoration have a long-term duration. • The technique seems to be safe for the treatment of A2 Magerl fractures, without major complications in our study group.
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http://dx.doi.org/10.1007/s00330-018-5867-3DOI Listing
August 2019

Bone and Soft-Tissue Biopsies: What You Need to Know.

Semin Intervent Radiol 2018 Oct 5;35(4):215-220. Epub 2018 Nov 5.

2nd Radiology Department, "ATTIKON" University General Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Percutaneous, image-guided musculoskeletal biopsy, due to its minimal invasive nature, when compared with open surgical biopsy, is a safe and effective technique which is widely used in many institutions as the primary method to acquire tissue and bone samples. Indications include histopathologic and molecular assessment of a musculoskeletal lesion, exclusion of malignancy in a bone/vertebral fracture, examination of bone marrow, and infection investigation. Preprocedural workup should include both imaging (for lesion assessment and staging) and laboratory (including coagulation tests and platelet count) studies. In selected cases, antibiotic prophylaxis should be administered before the biopsy. Core needle biopsy of musculoskeletal lesions has a diagnostic accuracy that ranges from 66 to 98% with higher diagnostic yield for lytic, large-size, malignant lesions and when multiple and long specimens are obtained. Reported complication rates range between 0 and 10% and usually do not exceed 5%, with a suggested threshold of 2%. The purpose of this review article is to illustrate the technical aspects, the indications, and the methodology of percutaneous image-guided bone biopsy that will assist the interventional radiologist to perform these minimal invasive techniques.
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http://dx.doi.org/10.1055/s-0038-1669467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6218252PMC
October 2018

Bleeding Remission with Microwave Ablation in a Transfusion-Dependent Patient with Hemorrhaging Angiosarcoma of the Pleura.

J Vasc Interv Radiol 2018 09;29(9):1298-1300

Second Department of Radiology, "Attikon" University General Hospital, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini str, Haidari, Athens 12462, Greece.

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http://dx.doi.org/10.1016/j.jvir.2018.03.019DOI Listing
September 2018

New Implant-Based Technologies in the Spine.

Cardiovasc Intervent Radiol 2018 Oct 22;41(10):1463-1473. Epub 2018 May 22.

2nd Radiology Department, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Haidari/Athens, Greece.

Vertebral compression fractures (VCFs) may result in a kyphotic deformity which can cause potential systemic complications secondary to respiratory and gastrointestinal dysfunction. The use of implants in the spine for VCF treatment represents a paradigm shift away from cement injection on its own, aiming to combine the analgesic and stabilizing effect of injecting cement into the vertebral body with vertebral height restoration and kyphotic angle correction. Spine implants which can be used for VCF treatment include stents, jacks, PEEK cages and fracture reduction systems. Lumbar spinal stenosis (LSS) with neurogenic intermittent claudication is one of the most commonly occurring spinal conditions, usually affecting people older than 50, which can cause disability and a reducted quality of life. Percutaneous interspinous spacers for the relief of symptoms caused by spinal stenosis can be used in patients who are not surgical candidates. The purpose of this article is to describe the basic concepts of spinal implantation in patients with VCF or spinal stenosis. The role of biomechanics and the different types of implants will be described. Controversies concerning techniques and products will be addressed. Finally, the necessity for an individually tailored approach for the use of different implants in different cases and anatomic locations will be emphasized.
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http://dx.doi.org/10.1007/s00270-018-1987-zDOI Listing
October 2018

Metastatic Osseous Pain Control: Bone Ablation and Cementoplasty.

Semin Intervent Radiol 2017 Dec 14;34(4):328-336. Epub 2017 Dec 14.

Division of Diagnostic and Interventional Radiology, 2nd Department of Radiology, University General Hospital "ATTIKON," Athens, Greece.

Nociceptive and/or neuropathic pain can be present in all phases of cancer (early and metastatic) and are not adequately treated in 56 to 82.3% of patients. In these patients, radiotherapy achieves overall pain responses (complete and partial responses combined) up to 60 and 61%. On the other hand, nowadays, ablation is included in clinical guidelines for bone metastases and the technique is governed by level I evidence. Depending on the location of the lesion in the peripheral skeleton, either the Mirels scoring or the Harrington (alternatively the Levy) grading system can be used for prophylactic fixation recommendation. As minimally invasive treatment options may be considered in patients with poor clinical status or limited life expectancy, the aim of this review is to detail the techniques proposed so far in the literature and to report the results in terms of safety and efficacy of ablation and cementoplasty (with or without fixation) for bone metastases. Percutaneous image-guided treatments appear as an interesting alternative for localized metastatic lesions of the peripheral skeleton.
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http://dx.doi.org/10.1055/s-0037-1608747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5730439PMC
December 2017

Epidural interlaminar injections in severe degenerative lumbar spine: fluoroscopy should not be a luxury.

J Neurointerv Surg 2018 Jun 12;10(6):592-595. Epub 2017 Sep 12.

Second Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital 'ATTIKON', Marousi, Athens, Greece.

Objective: To assess technical efficacy, accuracy, and safety of epidural (interlaminar) injections performed blindly in patients with a severely degenerated lumbar spine.

Methods: Over 12 consecutive months, 138 patients with a severe degenerative lumbar spine underwent epidural (interlaminar) injection as therapy for low back pain and neuralgia. Patients had already undergone a blind epidural infiltration with minimum or no pain reduction. The session was repeated in the angiography suite. Patients were placed in the lateral decubitus position. The injection was performed without image guidance by an anaesthesiologist; the target level was defined before the beginning of the procedure. Once air resistance loss was felt it was presumed that the needle was inside the epidural space. Verification of needle position was performed by injection of 1-3 mL of iodinated contrast medium under fluoroscopy in a lateral projection.

Results: Correct needle position inside the epidural space was documented in 82/138 cases (59.4%); unexpected extraepidural location was seen in 56/138 cases (40.6%). Target level was reached in 96/138 cases (69.6%); in 42/138 cases (30.4%) the needle was positioned in a non-target level. In 5/138 (3.6%) cases, there was inadvertent intradural position of the needle. Image guidance was subsequently used for correct positioning of the needle, which was feasible in all cases.

Conclusion: Blind interlaminar epidural injections lack the accuracy of exact needle location that imaging guidance offers in approximately 40% of cases, when there is difficult spine anatomy and the initial epidural approach has failed to provide pain relief. Image guidance for interlaminar epidural injection ensures accurate needle placement, enhancing the safety and efficacy of the procedure.
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http://dx.doi.org/10.1136/neurintsurg-2017-013288DOI Listing
June 2018

Percutaneous Vertebroplasty and Kyphoplasty: Current Status, New Developments and Old Controversies.

Cardiovasc Intervent Radiol 2017 Dec 30;40(12):1815-1823. Epub 2017 Aug 30.

2nd Radiology Department, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 1 Rimini Str, Haidari, 12462, Athens, Greece.

Vertebroplasty and kyphoplasty are minimally invasive techniques applied for the treatment of vertebral fractures. Since not all vertebral compression fractures are the same, a tailored-based approach is necessary for optimum efficacy and safety results. Nowadays, different cements and materials are proposed as alternatives to the original poly-methylmethacrylate aiming to overcome the limitations and the risks governing its use. Both techniques are governed by high efficacy and low complication rates; multilevel treatment in a single session has been shown to be feasible with no compromise of the technique's safety and efficacy. The purpose of this article is to describe the basic concepts of spinal augmentation by means of vertebroplasty and kyphoplasty. The current status and future of cements used will be defined. Controversies upon issues concerning both techniques will be addressed. Finally, the necessity for a tailored-based approach applying different techniques for different fractures will be addressed.
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http://dx.doi.org/10.1007/s00270-017-1779-xDOI Listing
December 2017

Computed tomography-guided percutaneous microwave ablation of hepatocellular carcinoma in challenging locations: safety and efficacy of high-power microwave platforms.

Int J Hyperthermia 2018 09 3;34(6):863-869. Epub 2017 Sep 3.

b 2nd Radiology Department , University General Hospital "ATTIKON" , Athens , Greece.

Objective: To evaluate the clinical efficacy/safety of CT-guided percutaneous microwave ablation for HCC in challenging locations using high-power microwave platforms.

Materials And Methods: A retrospective review was conducted in 26 patients with 36 HCC tumours in challenging locations (hepatic dome, subcapsular, close to the heart/diaphragm/hepatic hilum, exophytic) undergoing CT-guided percutaneous microwave ablation in a single centre since January 2011. Two different microwave platforms were used both operating at 2.45 GHz: AMICA and Acculis MWA System. Patient demographics including age, sex, tumour size and location, as well as technical details were recorded. Technical success, treatment response, patients survival and complication rate were evaluated.

Results: Treated tumours were located in the hepatic dome (n = 14), subcapsularly (n = 16), in proximity to the heart (n = 2) or liver hilum (n = 2), while two were exophytic tumours at segment VI (n = 2). Mean tumour diameter was 3.30 cm (range 1.4-5 cm). In 3/26 patients (diameter >4 cm), an additional session of DEB-TACE was performed due to tumour size. Technical success rate was 100%; complete response rate was recorded in 33/36 tumours (91.6%). According to Kaplan-Meier analysis, survival rate was 92.3% and 72.11% at 24- and 60-month follow-up, respectively. There were no major complications; two cases of minor pneumothorax and two cases of small subcapsular haematoma were resolved only with observation requiring no further treatment.

Conclusion: CT-guided percutaneous microwave ablation for hepatocellular carcinoma tumours in challenging locations and up to 5 cm in diameter can be performed with high efficacy and safety rates.
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http://dx.doi.org/10.1080/02656736.2017.1370728DOI Listing
September 2018

Metastatic bone disease from breast cancer: a review of minimally invasive techniques for diagnosis and treatment.

Eur J Orthop Surg Traumatol 2017 Aug 8;27(6):729-736. Epub 2017 Jun 8.

Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece.

Skeletal-related events in patients with metastatic bone disease include intractable severe pain, pathologic fracture, spinal cord and nerve compression, hypercalcemia and bone marrow aplasia. In patients with breast cancer, the skeleton is the most frequent site for metastases. Treatment options for metastatic bone disease in these patients include bisphosphonates, chemotherapeutic agents, opioids, hormonal therapy, minimally invasive/interventional and surgical techniques. Interventional oncology techniques for breast cancer patients with bone metastases include diagnostic (biopsy) and therapeutic (palliative and curative) approaches. In the latter, percutaneous ablation, augmentation and stabilization are included. The purpose of this article is to describe the basic concepts of biopsy, ablation, embolization and peripheral skeleton augmentation techniques in patients with metastatic bone disease from breast carcinoma. The necessity for a tailored approach applying different techniques for different cases and locations will be addressed.
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http://dx.doi.org/10.1007/s00590-017-1986-9DOI Listing
August 2017

A review of percutaneous techniques for low back pain and neuralgia: current trends in epidural infiltrations, intervertebral disk and facet joint therapies.

Br J Radiol 2016 14;89(1057):20150357. Epub 2015 Oct 14.

2nd Radiology Department, University General Hospital "ATTIKON", Athens, Greece.

Low back pain and neuralgia due to spinal pathology are very common symptoms debilitating numerous patients with peak prevalence at ages between 45 and 60 years. Intervertebral discs and facet joints act as pain sources in the vast majority of the cases. Diagnosis is based on the combination of clinical examination and imaging studies. Therapeutic armamentarium for low back pain and neuralgia due to intervertebral discs and/or facet joints includes conservative therapy, injections, percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments which can be performed as outpatient procedures. In cases of facet joint syndrome, they include, apart from injections, neurolysis with radiofrequency/cryoablation, MR-guided high-intensity focused ultrasound and percutaneous fixation techniques. In case of discogenic pain, apart from infiltrations, therapeutic techniques can be classified in to two main categories: decompression (mechanical, thermal, chemical) techniques and biomaterials implantation/disc cell therapies. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. This article will report clinical and imaging findings for each pathology type and the association with treatment decision. In addition, we will describe in detail all possible treatment techniques for low back pain and neuralgia, and we will report recently published results of these techniques summarizing the data concerning safety and effectiveness as well as the level of evidence. Finally, we will try to provide a rational approach for the therapy of low back pain and neuralgia by means of minimally invasive imaging-guided percutaneous techniques.
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http://dx.doi.org/10.1259/bjr.20150357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985947PMC
May 2016

Percutaneous Facet Screw Fixation in the Treatment of Symptomatic Recurrent Lumbar Facet Joint Cyst: A New Technique.

Cardiovasc Intervent Radiol 2016 Jan 6;39(1):127-31. Epub 2015 May 6.

University General Hospital "ATTIKON", Athens, Greece.

We present a case of percutaneous treatment of symptomatic recurrent lumbar facet joint cyst resistant to all medical treatments including facet joint steroid injection. Percutaneous transfacet fixation was then performed at L4-L5 level with a cannulated screw using CT and fluoroscopy guidance. The procedure time was 30 min. Using the visual analog scale (VAS), pain decreased from 9.5, preoperatively, to 0 after the procedure. At 6-month follow-up, an asymptomatic cystic recurrence was observed, which further reduced at the 1-year follow-up. Pain remained stable (VAS at 0) during all follow-ups. CT- and fluoroscopy-guided percutaneous cyst rupture associated with facet screw fixation could be an alternative to surgery in patients suffering from a symptomatic recurrent lumbar facet joint cyst.
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http://dx.doi.org/10.1007/s00270-015-1106-3DOI Listing
January 2016