Publications by authors named "Jack W Jennings"

69 Publications

Bone Metastases: State of the Art in Minimally Invasive Interventional Oncology.

Radiographics 2021 Sep-Oct;41(5):1475-1492

From the Department of Radiology, University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033 (A.T.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.W.J.).

Bone is the third most common site involved by cancer metastases, and skeleton-related events such as intractable pain due to direct osseous tumor involvement, pathologic fracture, and neurologic deficits as a consequence of nerve or spinal cord compression often affect patients' functional independence and quality of life unfavorably. The annual medical-economic burden related to bone metastases is a substantial component of the total direct medical cost estimated by the National Institutes of Health. There have been substantial recent advances in percutaneous image-guided minimally invasive musculoskeletal oncologic interventions for the management of patients with osseous metastatic disease. These advances include thermal ablation, cementation with or without osseous reinforcement with implants, osteosynthesis, thermal and chemical neurolyses, and palliative injections, which are progressively incorporated into the management paradigm for such patients. These interventions are performed in conjunction with or are supplemented by adjuvant radiation therapy, systemic therapy, surgery, or analgesic agents to achieve durable pain palliation, local tumor control, or cure, and they provide a robust armamentarium for interventional radiologists to achieve safe and effective treatment in a multidisciplinary setting. In addition, these procedures are shifting the patient management paradigm in modern-era practice. The authors detail the state of the art in minimally invasive percutaneous image-guided musculoskeletal oncologic interventions and the role of radiologists in managing patients with skeletal metastases. RSNA, 2021.
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http://dx.doi.org/10.1148/rg.2021210007DOI Listing
September 2021

Bone marrow aspiration and biopsy: techniques and practice implications.

Skeletal Radiol 2021 Aug 16. Epub 2021 Aug 16.

Mallinckrodt Institute of Radiology, 510 South Kingshighway Blvd, St. Louis, MO, 63110, USA.

Bone marrow aspiration and biopsy (BMAB) is a valuable diagnostic procedure commonly performed for evaluation of a wide spectrum of diseases including hematologic abnormalities, nonhematologic malignancies, metabolic abnormalities, and tumor treatment response such as chemotherapy and bone marrow transplantation, hematologic tumor staging, and suspected infection in patients with fever of unknown origin. This minimally invasive intervention offers excellent safety profile and a high diagnostic yield. Radiologists should be familiar with clinical implications of BMAB for patient care and be able to implement various technical armamentarium available to achieve a safe intervention while maximizing procedure yield.
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http://dx.doi.org/10.1007/s00256-021-03882-wDOI Listing
August 2021

First in-human report of the clinical accuracy of thoracolumbar percutaneous pedicle screw placement using augmented reality guidance.

Neurosurg Focus 2021 08;51(2):E10

Departments of1Neurosurgery and.

Objective: Augmented reality (AR) is an emerging technology that has great potential for guiding the safe and accurate placement of spinal hardware, including percutaneous pedicle screws. The goal of this study was to assess the accuracy of 63 percutaneous pedicle screws placed at a single institution using an AR head-mounted display (ARHMD) system.

Methods: Retrospective analyses were performed for 9 patients who underwent thoracic and/or lumbar percutaneous pedicle screw placement guided by ARHMD technology. Clinical accuracy was assessed via the Gertzbein-Robbins scale by the authors and by an independent musculoskeletal radiologist. Thoracic pedicle subanalysis was also performed to assess screw accuracy based on pedicle morphology.

Results: Nine patients received thoracic or lumbar AR-guided percutaneous pedicle screws. The mean age at the time of surgery was 71.9 ± 11.5 years and the mean number of screws per patient was 7. Indications for surgery were spinal tumors (n = 4, 44.4%), degenerative disease (n = 3, 33.3%), spinal deformity (n = 1, 11.1%), and a combination of deformity and infection (n = 1, 11.1%). Presenting symptoms were most commonly low-back pain (n = 7, 77.8%) and lower-extremity weakness (n = 5, 55.6%), followed by radicular lower-extremity pain, loss of lower-extremity sensation, or incontinence/urinary retention (n = 3 each, 33.3%). In all, 63 screws were placed (32 thoracic, 31 lumbar). The accuracy for these screws was 100% overall; all screws were Gertzbein-Robbins grade A or B (96.8% grade A, 3.2% grade B). This accuracy was achieved in the thoracic spine regardless of pedicle cancellous bone morphology.

Conclusions: AR-guided surgery demonstrated a 100% accuracy rate for the insertion of 63 percutaneous pedicle screws in 9 patients (100% rate of Gertzbein-Robbins grade A or B screw placement). Using an ARHMS system for the placement of percutaneous pedicle screws showed promise, but further validation using a larger cohort of patients across multiple surgeons and institutions will help to determine the true accuracy enabled by this technology.
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http://dx.doi.org/10.3171/2021.5.FOCUS21217DOI Listing
August 2021

Musculoskeletal Oncologic Interventions: Proceedings from the Society of Interventional Radiology and Society of Interventional Oncology Research Consensus Panel.

J Vasc Interv Radiol 2021 07;32(7):1089.e1-1089.e9

Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN.

Musculoskeletal interventions are increasingly used with palliative and curative intent in the multidisciplinary treatment of oncology patients with bone and soft-tissue tumors. There is an unmet need for high-quality evidence to guide broader application and adoption of minimally invasive interventional technologies to treat these patients. Therefore, the Society of Interventional Radiology Foundation and the Society of Interventional Oncology collaborated to convene a research consensus panel to prioritize a research agenda addressing the gaps in the current evidence. This article summarizes the panel's proceedings and recommendations for future basic science and clinical investigation to chart the course for interventional oncology within the musculoskeletal system. Key questions that emerged addressed the effectiveness of ablation within specific patient populations, the effect of combination of ablation with radiotherapy and/or immunotherapy, and the potential of standardization of techniques, including modeling and monitoring, to improve the consistency and predictability of treatment outcomes.
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http://dx.doi.org/10.1016/j.jvir.2021.04.008DOI Listing
July 2021

Vertebral augmentation reduces the 12-month mortality and morbidity in patients with osteoporotic vertebral compression fractures.

Eur Radiol 2021 Apr 26. Epub 2021 Apr 26.

Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France.

Objectives: To investigate the 12-month all-cause mortality and morbidity in patients with osteoporotic vertebral compression fractures (OVCFs) undergoing vertebroplasty/balloon kyphoplasty (VP/BKP) versus non-surgical management (NSM).

Methods: Following a Medline and EMBASE search for English language articles published from 2010 to 2019, 19 studies reporting on mortality and morbidity after VP/BKP in patients with OVCFs were selected. The 12-month timeline was set due to the largest amount of data availability at such time interval. Estimates for each study were reported as odds ratios (OR) along with 95% confidence intervals (CI) and p values. Fixed or random-effects meta-analyses were performed. All tests were based on a two-sided significance level of 0.05.

Results: Pooled OR across 5 studies favored VP/BKP over NSM in terms of 12-month all-cause mortality (OR: 0.81 [95% CI: 0.46-1.42]; p = .46). Pooled OR across 11 studies favored VP/BKP over NSM in terms of 12-month all-cause morbidity (OR: 0.64 [95% CI: 0.31-1.30]; p = .25). Sub-analysis of data dealing with 12-month infective morbidity from any origin confirmed the benefit of VP/BKP over NSM (OR: 0.23 [95% CI, 0.02-2.54]; p = .23).

Conclusion: Compared to NSM, VP/BKP reduces the 12-month risk of all-cause mortality and morbidity by 19% and 36%, respectively. Moreover, VP/BKP reduces by 77% the 12-month risk of infection from any origin.

Key Points: • Compared to non-surgical management, vertebral augmentation reduces the 12-month risk of all-cause mortality by 19% and all-cause morbidity by 36%. • Vertebral augmentation reduces the 12-month risk of infection morbidity from any origin by 77%.
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http://dx.doi.org/10.1007/s00330-021-07985-9DOI Listing
April 2021

Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study.

Radiol Imaging Cancer 2021 03 12;3(2):e200101. Epub 2021 Feb 12.

Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Box 8131, St Louis, MO 63110 (J.W.J.); Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, Ga (J.D.P.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (J.G., A.G.); Department of Radiology, Institut Bergonié, Bordeaux, France (X.B., J.P.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.N.K., M.C.); Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (S.G., F.A.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.J.H.); Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI (J.I.); Departments of Radiology (F.P) and Interventional Radiology (C.M.), Centre Léon Bérard, Lyon, France; Department of Radiology, Ascension Providence Rochester Hospital, Rochester, Mich (P.J.L.); and Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, France (T.d.B., F.D.).

Purpose: To assess the clinical effectiveness of cryoablation for palliation of painful bone metastases.

Materials And Methods: MOTION (Multicenter Study of Cryoablation for Palliation of Painful Bone Metastases) (ClinicalTrials.gov NCT02511678) was a multicenter, prospective, single-arm study of adults with metastatic bone disease who were not candidates for or had not benefited from standard therapy, that took place from February 2016 to March 2018. At baseline, participants rated their pain using the Brief Pain Inventory-Short Form (reference range from 0 to 10 points); those with moderate to severe pain, who had at least one metastatic candidate tumor for ablation, were included. The primary effectiveness endpoint was change in pain score from baseline to week 8. Participants were followed for 24 weeks after treatment. Statistical analyses included descriptive statistics and logistic regression to evaluate changes in pain score over the postprocedure follow-up period.

Results: A total of 66 participants (mean age, 60.8 years ± 14.3 [standard deviation]; 35 [53.0%] men) were enrolled and received cryoablation; 65 completed follow-up. Mean change in pain score from baseline to week 8 was -2.61 points (95% CI: -3.45, -1.78). Mean pain scores improved by 2 points at week 1 and reached clinically meaningful levels (more than a 2-point decrease) after week 8; scores continued to improve throughout follow-up. Quality of life improved, opioid doses were stabilized, and functional status was maintained over 6 months. Serious adverse events occurred in three participants.

Conclusion: Cryoablation of metastatic bone tumors provided rapid and durable pain palliation, improved quality of life, and offered an alternative to opioids for pain control. Ablation Techniques, Metastases, Pain Management, Radiation Therapy/Oncology© RSNA, 2021.
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http://dx.doi.org/10.1148/rycan.2021200101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011449PMC
March 2021

Complications of Percutaneous Radiofrequency Ablation of Spinal Osseous Metastases: An 8-Year Single-Center Experience.

AJR Am J Roentgenol 2021 06 31;216(6):1607-1613. Epub 2021 Mar 31.

Mallinckrodt Institute of Radiology, St. Louis, MO.

The purpose of this article was to evaluate the complication rate of percutaneous radiofrequency ablation of spinal osseous metastases. This retrospective HIPAA-compliant study reviewed complications of radiofrequency ablation combined with vertebral augmentation performed on 266 tumors in 166 consecutive patients for management of vertebral metastases between January 2012 and August 2019. Common Terminology Criteria for Adverse Events (CTCAE) was used to categorize complications as major (grade 3-4) or minor (grade 1-2). Local tumor control rate as well as pain palliation effects evaluated by the Brief Pain Inventory scores determined 1 week, 1 month, 3 months, and 6 months after treatment were documented. Wilcoxon signed rank and Mann-Whitney tests were used for statistical analysis. Among 266 treated tumors, the total complication rate was 3.0% (8/266), the major complication rate was 0.4% (1/266), and the minor complication rate was 2.6% (7/266). The single major (CTCAE grade 3) periprocedural complication was characterized by lower extremity weakness, difficulty in urination, and lack of erection as a result of spinal cord venous infarct. The seven minor complications included four cases of periprocedural transient radicular pain (CTCAE grade 2) requiring transforaminal steroid injections, one case of delayed secondary vertebral body fracture (CTCAE grade 2) requiring analgesics, and two cases of asymptomatic spinal cord edema on routine follow-up imaging (CTCAE grade 1). The local tumor control rate was 78.9%. There were statistically significant pain palliation effects at all postprocedural time intervals ( < .001 for all). Radiofrequency ablation of spinal osseous metastases is safe with a 3.0% rate of complications.
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http://dx.doi.org/10.2214/AJR.20.23494DOI Listing
June 2021

Fluoroscopy-guided bone marrow aspiration and biopsy: technical note.

Diagn Interv Radiol 2021 Mar;27(2):283-284

Mallinckrodt Institute of Radiology, St.Louis, Missouri, USA.

Bone marrow aspiration and biopsy is a valuable procedure commonly utilized for evaluation of hematologic abnormalities, nonhematologic malignancies, metabolic abnormalities, tumor treatment response, and suspected infection in patients with fever of unknown origin. Imaging guidance with computed tomography (CT) is commonly utilized to improve safety and effectiveness of the procedure. Considering progressively increasing volume of complex CT-guided procedures as well as diagnostic CT imaging in most practices potentially resulting in limited availability of CT, a technique for fluoroscopy-guided bone marrow aspiration and biopsy is described with focus on advantages, which could be beneficial to most busy practices in modern era radiology.
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http://dx.doi.org/10.5152/dir.2021.20243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7963383PMC
March 2021

Vertebral Metastases: Minimally Invasive Percutaneous Thermal Ablation.

Tech Vasc Interv Radiol 2020 Dec 6;23(4):100699. Epub 2020 Oct 6.

Mallinckrodt Institute of Radiology, St. Louis, MO. Electronic address:

This article provides a step-by-step guide for minimally invasive percutaneous image-guided thermal ablation for treatment of vertebral metastases. Such interventions have proved safe and effective in management of selected patients with spinal metastases primarily to achieve pain palliation and local tumor control. Particular attention to patient selection guidelines, details of procedure techniques, thermal protection, adequacy of treatment, recognition and management of potential complications, and post-ablation imaging are essential for improved patient outcomes.
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http://dx.doi.org/10.1016/j.tvir.2020.100699DOI Listing
December 2020

Three-Column Classification System for Tibial Plateau Fractures: What the Orthopedic Surgeon Wants to Know.

Radiographics 2021 Jan-Feb;41(1):144-155. Epub 2020 Dec 4.

From the Mallinckrodt Institute of Radiology, Musculoskeletal Section, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110.

Recent orthopedic surgical literature emphasizes a three-column approach to understand and guide the treatment of tibial plateau fractures. This three-column classification system published in 2010 relies on preoperative CT images to depict injuries to the medial, lateral, and posterior columns of the tibial plateau and improves surgical outcomes in complex tibial plateau fractures with coronal fracture planes and posterior plateau fracture fragments requiring dorsal plating. Tibial plateau fracture classification systems traditionally used by radiologists and orthopedic surgeons, including the Schatzker and the Arbeitsgemeinschaft für Osteosynthesefragen-Orthopedic Trauma Association (AO-OTA) classification systems, rely on findings at anteroposterior radiography and lack the terminology to accurately characterize fractures in the coronal plane involving the posterior tibial plateau. Incorporating elements from the contemporary three-column classification system into radiology reports will enhance radiologists' descriptions of these injuries. It is essential for radiologists to understand the role of clinical assessment and the pertinent imaging findings taken into consideration by orthopedic surgeons in their management of these injuries. This understanding includes familiarity with injury patterns and how they relate to mechanism of injury, patient demographics, and underlying pertinent comorbidities. Evaluating findings on initial radiographs is the basis of tibial plateau fracture diagnosis. Additional information provided by preoperative cross-sectional imaging, including two-dimensional and three-dimensional CT and MRI in specific circumstances, aids in the identification of specific soft-tissue injuries and fracture morphologies that influence surgical management. These specific fracture morphologies and soft-tissue injuries should be identified and communicated to orthopedic surgeons for optimal patient management. RSNA, 2020.
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http://dx.doi.org/10.1148/rg.2021200106DOI Listing
December 2020

Spine-specific skeletal related events and mortality in non-small cell lung cancer patients: a single-institution analysis.

J Neurosurg Spine 2020 Nov 27:1-8. Epub 2020 Nov 27.

2Radiology, Washington University School of Medicine, St. Louis, Missouri.

Objective: The population prevalence of non-small cell lung cancer (NSCLC) continues to increase; however, data are limited regarding the incidence rate of skeletal related events (SREs) (i.e., surgery to the spinal column, radiation to the spinal column, radiofrequency ablation, kyphoplasty/vertebroplasty, spinal cord compression, or pathological vertebral body fractures) and their impact on overall mortality. In this study, the authors sought to estimate the incidence rates of SREs in NSCLC patients and to quantify their impact on overall mortality.

Methods: This was a single-institution retrospective study of patients diagnosed with NSCLC between 2002 and 2014. The incidence rates for bone metastasis and subsequent SREs (per 1000 person-years) by time since lung cancer diagnosis were calculated and analyses were stratified separately for each histological type. Incidence rates for mortality at 1, 2, and 3 years from diagnosis stratified by the presence of SREs were also calculated. Kaplan-Meier survival curves were constructed to describe crude survival ratios in patients with spine metastasis and SREs and those with spine metastasis but without SREs. These curves were used to estimate the 1- and 2-year survival rates for each cohort.

Results: We identified 320 patients with incident NSCLC (median follow-up 9.5 months). The mean ± SD age was 60.65 ± 11.26 years; 94.48% of patients were smokers and 60.12% had a family history of cancer. The majority of first-time SREs were pathological vertebral body compression fractures (77.00%), followed by radiation (35%), surgery (14%), and spinal cord compression (13.04%). Mortality rates were highest in NSCLC patients with spine metastasis who had at least 1 SRE. Stratifying by histological subtype, the incidence rate of mortality in patients with SRE was highest in the large cell cohort, 7.42 per 1000 person-years (95% CI 3.09-17.84 per 1000 person-years); followed by the squamous cell cohort, 2.49 per 1000 person-years (95% CI 1.87-3.32 per 1000 person-years); and lowest in the adenocarcinoma cohort, 1.68 per 1000 person-years (95% CI 1.46-1.94 per 1000 person-years). Surgery for decompression of neural structures and stabilization of the spinal column was required in 6% of patients.

Conclusions: SREs in NSCLC patients with bone metastasis are associated with an increased incidence rate of mortality.
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http://dx.doi.org/10.3171/2020.7.SPINE20829DOI Listing
November 2020

Unifocal Langerhans cell histiocytosis of bone: percutaneous navigational bipolar radiofrequency ablation for curative treatment.

Clin Imaging 2021 Apr 14;72:55-57. Epub 2020 Nov 14.

Mallinckrodt Institute of Radiology, 510 South Kingshighway Blvd, St. Louis, MO 63110, USA. Electronic address:

In this report, the initial clinical experience of authors is described on the novel application of a navigational bipolar radiofrequency ablation electrode system for curative treatment of a painful unifocal Langerhans cell histiocytosis involving the supra-acetabular iliac bone. The technical success and safety of the radiofrequency ablation procedure to achieve cure suggests that this intervention may be utilized in clinical practice as a viable and minimally invasive alternative option, for management of unifocal Langerhans cell histiocytosis.
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http://dx.doi.org/10.1016/j.clinimag.2020.11.031DOI Listing
April 2021

Vertebral Hemangioma: Percutaneous Minimally Invasive Image-Guided Radiofrequency Ablation.

J Vasc Interv Radiol 2020 11;31(11):1949-1952.e1

Mallinckrodt Institute of Radiology, St. Louis, Missouri.

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http://dx.doi.org/10.1016/j.jvir.2020.06.015DOI Listing
November 2020

Evaluation of the Metastatic Spine Disease Multidisciplinary Working Group Algorithms as Part of a Multidisciplinary Spine Tumor Conference.

Global Spine J 2020 Oct 16;10(7):888-895. Epub 2019 Oct 16.

7548Washington University, St Louis, MO, USA.

Study Design: Retrospective cohort study.

Objective: The Metastatic Spine Disease Multidisciplinary Working Group Algorithms are evidence and expert opinion-based strategies for utilizing radiation therapy, interventional radiology procedures, and surgery to treat 5 types of spine metastases: asymptomatic spinal metastases, uncomplicated spinal metastases, stable vertebral compression fractures (VCF), unstable VCF, and metastatic epidural spinal cord compression (MESCC). Evaluation of this set of algorithms in a clinical setting is lacking. The authors aimed to identify rate of treatment adherence to the Working Group Algorithms and, subsequently, update these algorithms based on actual patient management decisions made at a single-institution, multidisciplinary, spine tumor conference.

Methods: Patients with metastatic spine disease from primary non-hematologic malignancies discussed at an institutional spine tumor conference from 2013 to 2016 were evaluated. Rates of Working Group Algorithms adherence were calculated for each type of metastasis. Based on the reasons for algorithm nonadherence, and patient outcomes in such cases, updated Working Group Algorithms recommendations were proposed.

Results: In total, 154 eligible patients with 171 spine metastases were evaluated. Rates of algorithm adherence were as follows: asymptomatic (67%), uncomplicated (73%), stable VCF (20%), unstable VCF (32%), and MESCC (41%). The most common deviation from the Working Group Algorithms was surgery for MESCC despite poor prognostic factors, but this treatment strategy was supported based on median survival surpassing 6 months in these patients.

Conclusions: Adherence to the Working Group Algorithm was lowest for MESCC and VCF patients, but many nonadherent treatments were supported by patient survival outcomes. We proposed updates to the Working Group Algorithm based on these findings.
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http://dx.doi.org/10.1177/2192568219882649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7485068PMC
October 2020

Biomechanics of the Osseous Pelvis and Its Implication for Consolidative Treatments in Interventional Oncology.

Cardiovasc Intervent Radiol 2020 Nov 26;43(11):1589-1599. Epub 2020 Aug 26.

Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67096, Strasbourg Cedex, France.

The osseous pelvis is a frequent site of metastases. Alteration of bone integrity may lead to pain but also to functional disability and pathological fractures. Percutaneous image-guided minimally invasive procedures, such as cementoplasty and screw fixation, have emerged as a viable option to provide bone reinforcement and fracture fixation, as stand-alone or combined techniques. Understanding the biomechanics of the osseous pelvis is paramount to tailor the treatment to the clinical situation. The purpose of the present review is to present the biomechanics of the osseous pelvis and discuss its implication for the choice of the optimal consolidative treatment.
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http://dx.doi.org/10.1007/s00270-020-02624-0DOI Listing
November 2020

Bone Biopsies: What Radiologists Need to Know.

AJR Am J Roentgenol 2020 09 13;215(3):523-533. Epub 2020 Jul 13.

Department of Radiology, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St. Louis, MO 63110.

The purpose of this article is to provide a step-by-step guide for bone imaging-guided percutaneous core needle biopsy, including the armamentarium available and the most recent advances. Bone imaging-guided percutaneous core needle biopsies are well-established, minimally invasive, cost-effective interventions for histologic characterization of bone lesions with an excellent safety profile and diagnostic outcomes; they play a crucial role in management of patients. Radiologists involved in the care of patients with bone lesions must be familiar with the various steps involved in such procedures and their role in patient management.
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http://dx.doi.org/10.2214/AJR.20.22809DOI Listing
September 2020

Efficacy and safety of bone marrow aspiration and biopsy using fluoroscopic guidance and a drill-powered needle: clinical experience from 775 cases.

Eur Radiol 2020 Nov 9;30(11):5964-5970. Epub 2020 Jun 9.

Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA.

Objectives: To evaluate the efficacy and safety of performing a fluoroscopically guided bone marrow aspiration and biopsy (BMAB) using a drill-powered needle in a large patient population.

Methods: This retrospective study received institutional review board approval with a waiver of patient informed consent. We identified all BMAB procedures from August 2012 through December 2016 performed at our institution using fluoroscopic guidance and a drill-powered needle. Clinical diagnosis, patient age, patient gender, biopsy site, biopsy needle gauge, bone marrow aspirate volume, bone marrow core biopsy length, patient platelet count, conscious sedation details, complications, and diagnostic adequacy were investigated for each case and summarized.

Results: A total of 775 BMAB procedures were performed and analyzed. These were performed in 436 female patients and 339 male patients ranging in age between 16 and 91 years (average age of 53 years). Samples obtained from the procedures in our series were diagnostic in 95.0% of cases. The complication rate for our series was 0.3%.

Conclusions: The use of fluoroscopic guidance and a drill-powered needle for bone marrow aspiration and biopsy is a safe and efficacious procedure.

Key Points: • Fluoroscopy can be utilized for imaging guidance during bone marrow aspiration and biopsy. • The use of fluoroscopic guidance and a drill-powered needle for bone marrow aspiration and biopsy has a high diagnostic yield. • The procedure has an excellent patient safety profile.
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http://dx.doi.org/10.1007/s00330-020-06987-3DOI Listing
November 2020

Digital Subtraction Air Arthrography: An Innovative Technique for Needle Tip Location Confirmation.

Curr Probl Diagn Radiol 2021 Jul-Aug;50(4):485-488. Epub 2020 May 13.

Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO.

Purpose: This article describes an innovative technique to confirm needle tip positioning using digital subtraction fluoroscopy and air within a targeted joint.

Materials And Methods: Digital subtraction fluoroscopy with air was utilized to confirm intra-articular needle tip position in 12 joints over a 14-month period at a single institution. Procedural details were recorded for each joint including: joint location, fluoroscopy time, patient age, patient body mass index, and change in subjective pain rating following the injection. Shoulder and hip phantoms were utilized to compare radiation dose differences between fluoroscopy with digital subtraction technique and fluoroscopy without digital subtraction technique.

Results: All of the 12 injections were technically successful with air clearly visualized within each targeted joint and subjective pain ratings either did not change or decreased following the injection. Patient age ranged from 51 to 87 years old and body mass index values ranged from 19.2 to 37.1 kg/m. Fluoroscopy times ranged from 11.1 to 32.9 seconds. There were no complications during or immediately following the injections. The addition of digital subtraction technique increased the skin dose at the shoulder by approximately 2.6 times and at the hip by approximately 2.2 times. Likewise, the cumulative dose at the shoulder increased by approximately 2.7 times and at the hip by 2.0 times.

Conclusion: Fluoroscopic digital subtraction air arthrography is a valuable option for needle tip confirmation when using air as a contrast agent. This novel combination of established fluoroscopic techniques can be incorporated into most clinical practices.
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http://dx.doi.org/10.1067/j.cpradiol.2020.04.003DOI Listing
May 2020

Percutaneous Minimally Invasive Thermal Ablation of Osseous Metastases: Evidence-Based Practice Guidelines.

AJR Am J Roentgenol 2020 08 26;215(2):502-510. Epub 2020 May 26.

Mallinckrodt Institute of Radiology, St. Louis, MO.

The objective of this article is to describe evidence-based guidelines for percutaneous minimally invasive imaging-guided thermal ablation of bone metastases. Safe and effective minimally invasive thermal ablation can be performed to achieve pain palliation, local tumor control, or cure in selected subgroups of patients with osseous metastases. Thermal protection strategies should be implemented to minimize the risk of undesired thermal injury.
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http://dx.doi.org/10.2214/AJR.19.22521DOI Listing
August 2020

Undifferentiated Pleomorphic Sarcoma and Hyperparathyroidism in an Adolescent Male: A Case Report and Review of Hyperparathyroidism-associated Sarcomas.

J Am Acad Orthop Surg Glob Res Rev 2020 02 10;4(2). Epub 2020 Feb 10.

Mallinckrodt Institute of Radiology (Herrmann, Stanborough, Jennings), and the Department of Pathology and Immunology (Chrisinger), Washington University, St. Louis, MO.

The association between hyperparathyroidism and sarcoma is extremely rare with other reported cases describing the development of osteosarcoma and chondrosarcomas in middle-aged adults. This case describes an adolescent male with hyperparathyroidism and a pathologic fracture of a biopsy-proven brown tumor in the distal right femur. The fracture healed but later developed an undifferentiated pleomorphic sarcoma of the bone at the site of the known brown tumor. Although in vitro and in vivo studies have demonstrated the risks of elevated parathyroid hormone with development of sarcomas, there is limited evidence of a human association. The effects of elevated parathyroid hormone on the skeletally immature bone in the setting of sarcoma formation are currently not well understood without current description of adolescent hyperparathyroidism-associated sarcomas. This case highlights a sarcoma originating at a pathologically proven brown tumor within an adolescent male, discusses the association of sarcoma with hyperparathyroidism, and reviews the other nine reported cases in the literature.
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http://dx.doi.org/10.5435/JAAOSGlobal-D-19-00125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7209809PMC
February 2020

Percutaneous Interventional Techniques for Treatment of Spinal Metastases.

Semin Intervent Radiol 2020 Jun 14;37(2):192-198. Epub 2020 May 14.

Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri.

This article details an approach for evaluation as well as minimally invasive percutaneous treatment of spinal metastases focusing on thermal ablation and most recent advances. Safe and effective management of certain subgroups of patients with spinal metastases can be achieved by minimally invasive percutaneous thermal ablation with or without vertebral augmentation. Adjunctive palliative treatment options such as epidural or neuroforaminal corticosteroid and long-acting anesthetic injections may also be performed in patients who have nerve and radicular pain including those who are not candidates for thermal ablation. Thermal protection strategies should be implemented to minimize the risk of neural thermal injury.
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http://dx.doi.org/10.1055/s-0040-1709205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224968PMC
June 2020

Utility of Motor and Somatosensory Evoked Potentials for Neural Thermoprotection in Ablations of Musculoskeletal Tumors.

J Vasc Interv Radiol 2020 Jun 25;31(6):903-911. Epub 2020 Apr 25.

Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., St. Louis, MO 63110. Electronic address:

Purpose: To characterize the utility of monitoring transcranial electrical motor evoked potentials (TCeMEPs) and somatosensory evoked potentials (SSEPs) for neural thermoprotection during musculoskeletal tumor ablations.

Materials And Methods: Retrospective review of 29 patients (16 male; median age, 46 y; range, 7-77 y) who underwent musculoskeletal tumor radiofrequency ablation (n = 8) or cryoablation (n = 22) with intraprocedural TCeMEP and SSEP monitoring was performed. The most common tumor histologies were osteoid osteoma (n = 6), venous malformation (n = 5), sarcoma (n = 5), renal cell carcinoma (n = 4), and non-small-cell lung cancer (n = 3). The most common tumor sites were spine (n = 22) and lower extremities (n = 4). Abnormal TCeMEP change was defined by 100-V increase above baseline threshold activation for a given myotome; abnormal SSEP change was defined by 60% reduction in baseline amplitude and/or 10% increase in latency.

Results: Abnormal changes in TCeMEP (n = 9; 30%) and/or SSEP (n = 5; 17%) occurred in 12 procedures (40%) and did not recover in 5 patients. Patients with unchanged TCeMEP/SSEP activities throughout the procedure (n = 18) did not have motor or sensory symptoms after the procedure; 3 (60%) with unrecovered activity changes and 2 (29%) with transient activity changes had new motor (n = 1) or sensory (n = 4) symptoms. Relative risk for neurologic sequelae for patients with unrecovered TCeMEP/SSEP changes vs those with transient or no changes was 7.50 (95% confidence interval, 1.66-33.9; P = .009).

Conclusions: Abnormal activity changes of TCeMEP or SSEP during percutaneous ablative procedures correlate with postprocedural neurologic sequelae.
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http://dx.doi.org/10.1016/j.jvir.2019.12.015DOI Listing
June 2020

Percutaneous Consolidation for Extraspinal Osteolytic Lesions: To Cementoplasty and Beyond.

J Vasc Interv Radiol 2020 04;31(4):659-660

Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.

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http://dx.doi.org/10.1016/j.jvir.2019.12.014DOI Listing
April 2020

Vertebral Augmentation Is More than Just Pain Palliation, It Is about Improved Mortality.

Authors:
Jack W Jennings

Radiology 2020 04 18;295(1):104-105. Epub 2020 Feb 18.

From the Mallinckrodt Institute of Radiology and Siteman Cancer Center, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110.

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http://dx.doi.org/10.1148/radiol.2020192806DOI Listing
April 2020

Percutaneous thermal ablation alone or in combination with cementoplasty for renal cell carcinoma osseous metastases: Pain palliation and local tumour control.

J Med Imaging Radiat Oncol 2020 Feb;64(1):96-103

Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA.

Introduction: To evaluate the safety and efficacy of minimally invasive percutaneous thermal ablation alone or in combination with cementoplasty for pain palliation and local tumour control of renal cell carcinoma osseous metastases.

Methods: Imaging-guided thermal ablation was performed in 59 renal cell carcinoma osseous metastatic tumours in 23 patients (concomitant cementoplasty in 43 tumours) selected following multidisciplinary consultations to achieve local tumour control and pain palliation (75%, 44/59) or pain palliation alone (25%, 15/59) in this retrospective study. Tumour characteristics, procedural details and complications were documented. Pain palliation was assessed using pre- and post-procedural Numeric Rating Scale scores at 1-week, 1-month, 3-month and 6-month time intervals. Pre- and post-procedural cross-sectional imaging was reviewed to assess local tumour control rates at 3-month, 6-month, and 12-month post-treatment time intervals.

Results: All procedures were technically successful and performed as pre-operatively planned. The median pre- and post-procedural Numeric Rating Scale scores were 8.0 and 3.0 (at all time intervals), respectively (P < 0.001). Local tumour control rates were 100% (40/40), 100% (36/36) and 85% (28/33) at ≥3 months, ≥6 months and ≥12 months post-procedural time intervals, respectively. There was 1 minor complication (1.7%, 1/59).

Conclusions: Percutaneous thermal ablation alone or in combination with cementoplasty is safe and effective for pain palliation and local tumour control of renal cell carcinoma osseous metastases.
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http://dx.doi.org/10.1111/1754-9485.12991DOI Listing
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

Hot and Cold Spine Tumor Ablations.

Neuroimaging Clin N Am 2019 Nov 2;29(4):529-538. Epub 2019 Aug 2.

Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA. Electronic address:

The vertebral column is the most common site of osseous metastasis, and percutaneous minimally invasive thermal ablation is becoming an important contributor to multidisciplinary treatment algorithms. Continuously evolving minimally invasive image-guided percutaneous spine thermal ablation procedures have proven safe and effective in management of selected patients with spinal metastases to achieve pain palliation and/or local tumor control. This article details the armamentarium available and the most recent advances in minimally invasive, percutaneous image-guided thermal ablation for management of spinal metastases.
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http://dx.doi.org/10.1016/j.nic.2019.07.001DOI Listing
November 2019

Percutaneous minimally invasive thermal ablation for management of osseous metastases: recent advances.

Int J Hyperthermia 2019 10;36(2):3-12

Mallinckrodt Institute of Radiology, Washington University in Saint Louis , St. Louis , MO , USA.

Minimally invasive percutaneous thermal ablation of osseous metastases has proved safe and effective in management of selected patients with bone metastatic disease. These procedures have become a part of the treatment algorithm for certain subgroup of patients with osseous metastases to achieve pain palliation and/or local tumor control. This review details the armamentarium available and the most recent advances in minimally invasive, percutaneous image-guided thermal ablation for management of osseous metastases.
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http://dx.doi.org/10.1080/02656736.2019.1613573DOI Listing
October 2019

How Effective Are Noninvasive Tests for Diagnosing Malignant Peripheral Nerve Sheath Tumors in Patients with Neurofibromatosis Type 1? Diagnosing MPNST in NF1 Patients.

Sarcoma 2019 1;2019:4627521. Epub 2019 Jul 1.

Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA.

Background: Distinguishing between benign and malignant peripheral nerve sheath tumors (MPNSTs) in neurofibromatosis 1 (NF1) patients prior to excision can be challenging. How can MPNST be most accurately diagnosed using clinical symptoms, magnetic resonance imaging (MRI) findings (tumor size, depth, and necrosis), positron emission tomography (PET) measures (SUV, SUV, SUV/SUV, and qualitative scale), and combinations of the above? . All NF1 patients who underwent PET imaging at our institution (January 1, 2007-December 31, 2016) were included. Medical records were reviewed for clinical findings; MR images and PET images were interpreted by two fellowship-trained musculoskeletal and nuclear medicine radiologists, respectively. Receiver operating characteristic (ROC) curves were created for each PET measurement; the area under the curve (AUC) and thresholds for diagnosing malignancy were calculated. Logistic regression determined significant predictors of malignancy.

Results: Our population of 41 patients contained 34 benign and 36 malignant tumors. Clinical findings did not reliably predict MPNST. Tumor depth below fascia was highly sensitive; larger tumors were more likely to be malignant but without a useful cutoff for diagnosis. Necrosis on MRI was highly accurate and was the only significant variable in the regression model. PET measures were highly accurate, with AUCs comparable and cutoff points consistent with prior studies. A diagnostic algorithm was created using MRI and PET findings.

Conclusions: MRI and PET were more effective at diagnosing MPNST than clinical features. We created an algorithm for preoperative evaluation of peripheral nerve sheath tumors in NF1 patients, for which additional validation will be indicated.
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http://dx.doi.org/10.1155/2019/4627521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636541PMC
July 2019
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