Search

This article reviews the technique, results, and complications of percutaneous biopsies of soft tissue tumors. Biopsy of soft tissue tumors may be achieved either with fine needles or core-biopsy needles. The choice between the two biopsy techniques ultimately depends on the experience of the radiologist and pathologist. Since an inadequate technique may severely affect final treatment, the biopsy track should be discussed with the surgeon responsible for future management each time a primary tumor is suspected.

Lumbar chemonucleolysis is an alternative treatment of the sciatic pain due to a disc herniation. It gives good results in 70 to 80% of selected patients. When a correct technique is used, the complication rate is lesser than that of the open surgery. The indications of lumbar chemonucleolysis are larger than in the past and include lateral disc herniations, large or migrated disc herniations, and patients under 18 years or over 60 years. Further studies are necessary to determine if magnetic resonance imaging helps in patients selection and improve the success rate of chemonucleolysis.

Needle aspiration of tendinous calcific deposits under fluoroscopic control may be a valuable tool in selected cases of painful shoulders with chronic and debilitating pain resistant to medical treatment. This article reviews the technique and results of this treatment. The aims of this procedure are (1) to evacuate a maximum amount of calcium; (2) to fragment the residual calcific deposits to facilitate its resorption during the following weeks; (3) to reduce the inflammation secondary to the presence and migration of residual calcific deposits by in situ injection of corticosteroids. Good results are obtained in 61Ð74% of cases. Surgical treatment should be restricted to failures of needle aspiration.

Techniques of percutaneous synovial biopsy under fluoroscopic control of large joints of the limbs (other than the knee) may be useful in arthritis of undetermined etiology especially when infection is considered. Main technical refinements include adequate selection of an optimal approach and biopsy site using new imaging methods, use of a Tru-Cut(R) needle, and placement of the cutting window tangential to the joint surface, and selection of an optimal approach and biopsy site. Detailed technique of the synovial biopsy of hip, ankle, shoulder, and elbow joints is discussed.

Distension arthrography under fluoroscopic control may be useful in frozen shoulder syndrome. The technique consists of an intra-articular injection of 2 to 3 mL of contrast material, 3 mL of 2% lidocaine, 1.5 mL of cortivazol, and distension of the joint capsule with 30 to 40 mL of refrigerated sterile saline solution. This injection is immediately followed by a physiotherapy program. The authors report their experience of distension arthography in 30 shoulders. Results were good to very good in 90% of cases at 40-day follow-up. No recurrence of a frozen shoulder syndrome was observed and no complications were encountered in this series.

Percutaneous biopsy is a minimally invasive technique that yields a high diagnostic accuracy at a relatively low cost in musculoskeletal lesions, especially tumors and infection. In this article, technical refinements improving the results of percutaneous biopsy of musculoskeletal lesions are reviewed, especially the type of radiological guidance, the different biopsy needles available, and the technique of approach depending on the lesion site. Reported complications, results, and indications of musculoskeletal percutaneous biopsy are also discussed.

Steroid joint injections may be effective in painful joints due to degenerative disease and posttraumatic changes, as well as rheumatoid arthritis and seronegative spondylarthropathy. Fluoroscopic guidance may be necessary for deep (sacroiliac, hip, and shoulder) or small (wrist, hand, and foot) joints. Detailed technique of the steroid injection is given, especially for the sacroiliac joint.

Osteoid osteomas in almost all locations may be treated by percutaneous resection under CT scan guidance. The authors give their own experience with a series of 30 cases. The different techniques of percutaneous resection reported in the literature are reviewed. Advantages of the percutaneous resection are compared to those of classical surgery and other percutaneous techniques such as lesion destruction with thermocoagulation, photocoagulation, and intralesional injection of alcohol.