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CBCT Shows Promise for Liver Malignancy Interventions

Interventional therapies, including transarterial chemoembolization (TACE), yttrium-90 selective internal radiation therapy, and ablation, are pivotal in treating liver malignancies. These interventions are commonly guided by imaging techniques such as digital subtraction angiography (DSA), CT, ultrasonography, or MRI. Nonetheless, each imaging modality has inherent limitations. DSA, for example, provides 2D images of blood vessels and tumor staining, which may fall short of specific procedures. Ultrasonography struggles with visualizing small lesions and those near the diaphragm, while CT lacks real-time imaging capabilities.

Cone-beam CT (CBCT), a volumetric imaging technique utilizing a cone-shaped X-ray beam, offers a promising alternative. It facilitates automatic detection and navigation of target vessels, fluoroscopy, and post-TACE embolization assessment, potentially overcoming some limitations of traditional imaging methods. Despite its recognized importance in liver malignancy interventions, CBCT's integration into clinical practice faces challenges such as limited awareness among interventional radiologists, inconsistent parameter standardization, and restricted application areas. To address these issues, the Chinese College of Interventionalists has issued a consensus statement to standardize and promote CBCT use in liver malignancy therapies. This statement, grounded in evidence-based practices and clinical expertise, has been registered on the International Practice Guidelines Registration and Transparency Platform (Registration number: PREPARE-2023CN980).

The consensus outlines CBCT scanning techniques, operational standards, and clinical applications while addressing its challenges, including limited soft-tissue contrast, radiation exposure, image artifacts, resolution constraints, and a narrow field of view. Despite these hurdles, CBCT’s future is bright, with anticipated advancements in detector resolution, reconstruction algorithms, and multimodal imaging integration. Innovations aimed at reducing radiation doses, enhancing real-time imaging, and incorporating AI are expected to refine CBCT’s accuracy and safety, solidifying its role in the interventional management of liver malignancies.

In summary, CBCT represents a significant advancement in imaging for liver malignancy interventions, offering solutions to some limitations of traditional modalities. Despite current challenges, ongoing technological innovations and the integration of AI hold great promise for enhancing CBCT’s efficacy and safety in clinical practice.

— Source: Xia & He Publishing Inc

Minimally Invasive Procedure Relieves Knee Arthritis

A minimally invasive procedure provides significant relief from knee pain and may prevent the need for knee replacement surgery in people with osteoarthritis, according to a study presented at RSNA 2024.

"This study addresses osteoarthritis, which is a significant public health issue and the leading cause of chronic pain and disability worldwide," says the study's lead author, Florian Nima Fleckenstein, MD, an interventional radiologist at Charité—University Hospital Berlin in Germany. "With millions of people affected by knee osteoarthritis, particularly in aging populations, finding effective, minimally invasive treatments is critical."

Osteoarthritis, a chronic, degenerative, and progressive condition, is the most common cause of chronic joint disorders. According to the World Health Organization, knee osteoarthritis affects over 365 million adults worldwide. Most available therapies, such as pain medication and steroid injections, only mask the symptoms of osteoarthritis. They don't slow progression of the disease. As osteoarthritis worsens and conservative treatments become ineffective, many people turn to joint replacement surgery.

Genicular artery embolization (GAE) is an innovative, minimally invasive therapy for patients with symptomatic knee osteoarthritis. The genicular arteries have several branches that form a network around the knee joint. These vessels are altered in patients suffering from osteoarthritis. In GAE, an interventional radiologist injects small particles into selected branches that correspond to the site of knee pain to block blood flow to that area. Embolization of the abnormal blood vessels helps disrupt the cycle of inflammation, cartilage destruction, and sensory nerve growth that characterizes osteoarthritis.

For the study, Fleckenstein and colleagues conducted a retrospective analysis of 403 cases from patients (age 40 to 90) with moderate to severe knee osteoarthritis who didn't respond to conservative treatments. All patients underwent GAE at the Charité – University Hospital Berlin. The study was designed to evaluate both the safety and efficacy of GAE across a broad spectrum of osteoarthritis severities. The effectiveness of the procedure was measured using the Visual Analog Scale and the Knee Injury and Osteoarthritis Outcome Score. These standardized scores, which measure pain and quality of life, were recorded at baseline and during follow-up visits at six weeks, three months, six months, and one year postprocedure.

Technical success was achieved in 100% of procedures. Temporary slight skin discoloration and mild knee pain immediately after the procedure were noted in 18% of all cases. No severe complications were reported. The quality-of-life index and pain score improved by 87% and 71%, respectively, at one-year follow-up. The findings show that GAE is a safe and effective treatment option across all severity grades of knee osteoarthritis, including advanced cases where other treatments have very limited efficacy.

"Our study found that GAE can effectively reduce knee pain and improve quality of life early after the treatment, with these benefits being maintained over the long term, especially for people who haven't had success with other treatments like physical therapy or pain medications," Fleckenstein says. "This could potentially offer a new lease on life for many patients who suffer from debilitating pain and mobility issues caused by osteoarthritis."

However, the study also showed that GAE is particularly effective in the early stages of knee osteoarthritis. This indicates that early intervention could potentially delay or even prevent disease progression, reducing the need for more invasive treatments such as surgery. The researchers hope that by demonstrating the procedure's success in a large and diverse patient population, the study could influence medical practice and policy, encouraging broader adoption of GAE in clinical settings worldwide.

"GAE has the potential to reduce the need for more invasive surgeries, lower health care costs, and significantly improve the quality of life for countless individuals suffering from knee osteoarthritis," Fleckenstein says.

He and his team plan to continue their research on degenerative joint disorders to provide patients with new options in the field of IR.

— Source: RSNA