Paediatric musculoskeletal interventional radiology

Abstract

Interventional radiology technique is now well established and widely used in the adult population. Through minimally invasive procedures, it increasingly replaces surgical interventions that involve higher percentages of invasiveness and, consequently, of morbidity and mortality. For these advantageous reasons, interventional radiology in recent years has spread to the paediatric age as well. The aim of this study was to review the literature on the development, use and perspectives of these procedures in the paediatric musculoskeletal field. Several topics are covered: osteomuscle neoplastic malignant and benign pathologies treated with invasive diagnostic and/or therapeutic procedures such as radiofrequency ablation in the osteoid osteoma; invasive and non-invasive procedures in vascular malformations; treatment of aneurysmal bone cysts; and role of interventional radiology in paediatric inflammatory and rheumatic inflammations. The positive results that have been generated with interventional radiology procedures in the paediatric field highly encourage both the development of new ad hoc materials, obviously adapted to young patients, as well as the improvement of such techniques, in consideration of the fact that childrens' pathologies do not always correspond to those of adults. In conclusion, as these interventional procedures have proven to be less invasive, with lower morbidity and mortality rates as well, they are becoming a viable and valid alternative to surgery in the paediatric population. MUSCULOSKELETAL MALIGNANT TUMOURSOsteosarcoma, Ewing sarcoma and rhabdomyosarcoma are the most common musculoskeletal tumours of childhood and adolescence.

A single‐institution pediatric and young adult interventional oncology collaborative: Novel therapeutic options for relapsed/refractory solid tumors

“…The authors primarily report on technical endpoints noting significant limitations in collecting clinically annotated data 17 . While limited by the lack of clinically relevant endpoints, these publications support the safety and tolerability of PIO procedures 17–19 …”

“… 17 While limited by the lack of clinically relevant endpoints, these publications support the safety and tolerability of PIO procedures. 17 , 18 , 19 …”

“…17 While limited by the lack of clinically relevant endpoints, these publications support the safety and tolerability of PIO procedures. [17][18][19] There is existing literature regarding consensus use of PIO procedures to treat osteoid osteomas [20][21][22] and accumulating experience regarding the treatment of pediatric patients with primary liver tumors or retinoblastoma. [23][24][25][26][27][28][29][30] Our single-institution experience provides insight regarding additional patient cohorts to potentially pursue for future study.…”

Impact of radiation dose reduction and iterative image reconstruction on CT-guided spine biopsies

“…Despite a considerable reduction of the radiation dose during CT-guided percutaneous lung biopsies by more than 90% (from DLP of 677.5 mGy*cm to 18.3 mGy*cm), Smith et al found no relevant decrease in technical success or patient safety 25 . Furthermore, especially for pediatric CT scanning, many studies were able to show that CTguided bone biopsies performed using techniques for lowering radiation exposure can also lead to acceptable image quality and provide similar diagnostic yield compared with SD protocols [29][30][31] .…”

Management of Osteoblastoma and Giant Osteoid Osteoma with Percutaneous Thermoablation Techniques

“…The majority of operators use a device for temperature control. In this way, the temperature reaches 90 • C and is maintained for 4 or 6 min, till complete and radical ablation [17] (Figure 2a,b). After treatment, the patients can load weight on the treated area.…”