Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3974_Библиотеки_им_академика_М_И_Перельмана
.pdf
x
Contents
9 Thoracic Ablation: Primary Lung Cancer, Metastases,
Chest Wall Disease .................................................................................. 97
Shuvro Roy-Choudhury
10 Hepatic Ablation: Hepatocellular Carcinoma and Metastases ........... 115
Ronald S. Winokur and Daniel B. Brown
11 Renal Ablation ......................................................................................... 139
Nicos Fotiadis
12 Adrenal Ablation: Primary Tumors and Metastatic Disease .............. 147
Michael D. Beland and William W. Mayo-Smith
13 Prostate Ablation ..................................................................................... 159
Georgia Tsoumakidou, Hervé Lang,
and Afshin Gangi
14 Ablation of Primary Bone and Soft Tissue Tumors ............................. 173
Katsanos Konstantinos and Theodore Petsas
Index ................................................................................................................. 183
https://t.me/med1917
xi
Contributors
Irfan Ahmed , M.B.B.S., MRCP, FRCR Department of Radiology , Guy’s and St
Thomas’ Foundation Trust, St Thomas’ Hospital , London , UK
Jung Hwan Baek , M.D. Department of Radiology and Research Institute of Ra-
diology , University of Ulsan College of Medicine, Asan Medical Center , Seoul ,
South Korea
Michael D. Beland , M.D. Department of Diagnostic Imaging , Rhode Island Hospi-
tal, The Warren Alpert Medical School of Brown University , Providence , RI , USA
Rachel R Bitton , Ph.D. Department of Radiology , Lucas Center for Imaging,
Stanford University, School of Medicine , Stanford , CA , USA
Chris L. Brace , Ph.D. Department of Radiology , University of Wisconsin, School
of Medicine and Public Health , Madison , WI , USA
Department of Radiology , University of Wisconsin Hospital and Clinics , Madison ,
WI , USA
Departments of Biomedical Engineering and Medical Physics , University of
Wisconsin, School of Medicine and Public Health , Madison , WI , USA
Daniel B. Brown , M.D. Division of Interventional Radiology, Department
of Radiology , Thomas Jefferson University , Philadelphia , PA , USA
Timothy Clark , M.D., FSIR Department of Radiology, Section of Vascular and
Interventional Radiology , University of Pennsylvania , Philadelphia , PA, USA
Xavier Buy , M.D. Department of Interventional Radiology , University Hospital of
Strasbourg , Strasbourg , France
Bruce L. Daniel , M.D. Department of Radiology , Stanford University, School of
Medicine , Stanford , CA , USA
Iulian Enescu , M.D. Department of Interventional Radiology , University Hospital
of Strasbourg , Strasbourg , France
https://t.me/med1917
xii
Contributors
Joseph P. Erinjeri , M.D., Ph.D. Interventional Radiology Service , Memorial
Sloan-Kettering Cancer Center , New York , NY , USA
Department of Radiology, Weill Cornell Medical College , New York , USA
Nicos Fotiadis , M.D., FRCR Department of Interventional Oncology , The Royal
Marsden NHS Foundation Trust , London , UK
Department of Interventional Radiology , St Bartholomew’s & The Royal London
Hospitals , London , UK
Afshin Gangi , M.D., Ph.D. Department of Interventional Radiology , University
Hospital of Strasbourg , Strasbourg , France
Department of Non-vascular Interventional Radiology , University Hospital of Stras-
bourg , Strasbourg , France
Julien Garnon , M.D. Department of Interventional Radiology , University Hospi-
tal of Strasbourg , Strasbourg , France
J. Louis Hinshaw , M.D. Department of Radiology , University of Wisconsin,
School of Medicine and Public Health , Madison , WI , USA
Department of Radiology , University of Wisconsin Hospital and Clinics ,
Madison , WI , USA
Jeffrey A. Klein , M.D. Department of Radiology , University of Wisconsin, School
of Medicine and Public Health , Madison , WI , USA
Department of Radiology , University of Wisconsin Hospital and Clinics ,
Madison , WI , USA
Katsanos Konstantinos , M.D., Ph.D., EBIR Department of Interventional
Radiology , Patras University Hospital (PGNP) , Rion, Patras , Greece
Miltiadis Krokidis , M.D., Ph.D., EBIR Department of Radiology , Guy’s and St
Thomas’ Foundation Trust, St Thomas’ Hospital , London , UK
Hervé Lang , M.D., Ph.D. Urology Department , University Hospital of Strasbourg ,
Strasbourg , France
Fred T. Lee , M.D. Department of Radiology , University of Wisconsin,
School of Medicine and Public Health , Madison , WI , USA
Department of Radiology , University of Wisconsin Hospital and Clinics , Madison ,
WI , USA
Meghan G. Lubner , M.D. Department of Radiology , University of Wisconsin,
School of Medicine and Public Health , Madison , WI , USA
Department of Radiology , University of Wisconsin Hospital and Clinics , Madison ,
WI , USA
https://t.me/med1917
xiii
Contributors
William W. Mayo-Smith , M.D. Department of Diagnostic Imaging ,
Rhode Island Hospital, The Warren Alpert Medical School of Brown University ,
Providence , RI , USA
Kim R. Butts Pauly , Ph.D. Department of Radiology , Lucas Center for Imaging,
Stanford University, School of Medicine , Stanford , CA , USA
Theodore Petsas , M.D., Ph.D. Department of Interventional Radiology , Patras
University Hospital (PGNP) , Rion, Patras , Greece
Shuvro Roy-Choudhury Diagnostic and Interventional Radiology , Fortis Hospi-
tals , Kolkata , West Bengal , India
Consultant Radiologist , Heart of England NHS Foundation Trust ,
Birmingham, UK
Georgia Tsoumakidou , M.D. Department of Interventional Radiology , University
Hospital of Strasbourg , Strasbourg , France
Department of Non-vascular Interventional Radiology , University Hospital
of Strasbourg , Strasbourg , France
Department of Urology , University Hospital of Strasbourg , Strasbourg , France
Ronald S. Winokur , M.D. Division of Interventional Radiology, Department
of Radiology , Thomas Jefferson University Hospital , Philadelphia , PA , USA
https://t.me/med1917
https://t.me/med1917
1
T. Clark, T. Sabharwal (eds.), Interventional Radiology Techniques in Ablation,
Techniques in Interventional Radiology,
DOI 10.1007/978-0-85729-094-6_1, © Springer-Verlag London 2013
The last 30 years have witnessed the emergence of a new clinical subspecialty in the
war against cancer – that of interventional oncology. Armed with ablation devices,
embolization agents, cytotoxic and radiotherapeutic agents, intravascular delivery
systems, and advances in imaging guidance, interventional oncologists have evolved
into a fourth pivotal member complementing the cancer-treating trifecta of medical,
surgical, and radiation oncologists. Interventional oncology is rapidly changing the
paradigm of modern cancer management by improving local control and even cure
of many solid organ malignancies. Image-guided tumor ablation is a fundamental
tool within the therapeutic array of the interventional oncologist and is the focus of
this book.
We have designed this book to be as practical as possible. It is organized to cover
the major ablation technologies in current clinical use in Technology Overview , fol-
lowed by Clinical Applications with an organ-based description of clinical applica-
tions of image-guided ablation in the fi eld of interventional oncology.
Leading off for the Technology Overview section of this book, Drs. Krokidis and
Ahmed in Chap. 2 provide insight into the mechanism of radiofrequency ablation,
information on electrode selection, and practical suggestions when using each of
the most widely used commercially available systems. Chapter 3 by Dr. Erinjeri
addresses cryoablation, including its mechanism of tumor destruction, components
required, and advantages and disadvantages. In Chap. 4 , Dr. Klein et al. discuss
microwave systems for tumor ablation, including mechanisms, components, advan-
tages/disadvantages, and future directions. Chapter 5 by Dr. Garnon et al. covers
high-intensity focused ultrasound, laser interstitial ablation, and chemical ablation.
T. Clark , M.D., FSIR
Department of Radiology, Section of Vascular and Interventional Radiology ,
Penn Presbyterian Medical Center and University of Pennsylvania Medical Center ,
39th and Market Streets , Philadelphia , PA 19104 , USA
e-mail: timothy.clark@uphs.upenn.edu
Chapter 1
Introduction
Timothy Clark
https://t.me/med1917
2
T. Clark
Chapter 6 by Dr. Konstantinos completes the Technology Overview section of the
book with a discussion of plasma-mediated coblation.
The Clinical Application section of the book takes a head-to-toe approach, and
begins in Chap.
7 with a description of ablation of thyroid and parathyroid nodules
by Dr. Baek. Chapter 8 by Drs. Bitton, Daniel, and Pauly addresses thermal ablation
of breast carcinoma and fi broadenomas, a fi eld that is expected to signi fi cantly grow
given the high incidence and prevalence of breast cancer. In Chap.
9 , Dr. Roy-
Chourhury describes the role and technique of lung tumor ablation, also expected to
experience signi fi cant growth given the epidemiology of primary lung carcinoma
and lung metastases. Drs. Winokur and Brown discuss thermal ablation of hepato-
cellular carcinoma and liver metastases in Chap. 10 , which remains the clinical
application of thermal ablation with the broadest worldwide experience. Chapter 11
by Dr. Fotiadis addresses thermal ablation of renal carcinoma, with unique consid-
erations in that most patients are treated with a completely curative intent. Chapter
12 by Drs. Beland and Mayo-Smith describe the use of thermal ablation of primary
adrenal tumors and adrenal neoplasms, including the need for preprocedural alpha
and beta blockade for functioning adrenal tumors. In Chap. 13 , Drs. Tsoumakidou,
Lang, and Gangi discuss the evolving role of thermal ablation for treatment of pros-
tate carcinoma, which is expected to extend the spectrum of patients in whom local
tumor control can be achieved. Finally, Chap. 14 by Drs. Konstantinos and Petsas
completes this book with a description of ablation of primary bone and soft tissue
tumors.
Tumor ablation is a rapidly evolving fi eld, both with emerging technologies and
new clinical applications. Some newer ablation technologies, such as irreversible
electroporation, have had insuf fi cient clinical experience at the time of publication
and are not addressed in the book; a number of these ablation modalities hold excit-
ing promise and their omission in this book should not be interpreted as an assess-
ment of their clinical potential. Similarly, the use of image-guided ablation in
diseases such as pancreatic adenocarcinoma is not addressed, as only preliminary
clinical data exist for these applications at present. We have also not addressed the
evolving technologies in image fusion, navigation, and robotic systems, which are
expected to enable tumor ablation to become safer, more precise, and faster.
We hope that you fi nd this handbook practical, well-organized, and clinically
relevant.
https://t.me/med1917
Part I
Technology Assessment
https://t.me/med1917
5
T. Clark, T. Sabharwal (eds.), Interventional Radiology Techniques in Ablation,
Techniques in Interventional Radiology,
DOI 10.1007/978-0-85729-094-6_2, © Springer-Verlag London 2013
Background
“Thermal ablation” is de fi ned as the application of heating agents to a speci fi c •
area of the body with the intention of tissue destruction.
The deleterious effect of heat is based on the fact that when biological tissues •
reach a temperature above 45°C, irreversible cell damage occurs.
Radiofrequency (RF) ablation is based on the interaction between high- frequency, •
rapidly alternating electric current and biological tissue.
The rapidly alternating electric current causes vibration movement of the tissue’s •
bipolar molecules (mostly water).
This vibration movement is transmitted between adjacent molecules with result-•
ing frictional energy loss.
The energy loss is deposited in the biological tissues in the form of a rise in •
temperature.
The rise in temperature leads initially to hyperthermia and then to “coagulation” •
necrosis.
Basic Principles
In RF ablation, necrosis is achieved with electromagnetic energy sources in the •
range of 375–500 kHz.
Available devices may be either monopolar or bipolar systems. •
M. Krokidis , M.D., Ph.D., EBIR (*) • I. Ahmed , M.B.B.S., MRCP, FRCR
Department of Radiology , Guy’s and St Thomas’ NHS Trust, St Thomas’ Hospital ,
1st Floor Lambeth Wing, Westminster Bridge Road , London SE1 7EH , UK
e-mail: miltiadis.krokidis@gstt.nhs.uk , mkrokidis@hotmail.com ; irfan.ahmed@gstt.nhs.uk
Chapter 2
Overview of Thermal Ablation Devices:
Radiofrequency Ablation
Miltiadis Krokidis and Irfan Ahmed
https://t.me/med1917
6
M. Krokidis and I. Ahmed
There are a variety of available electrodes (multitined, expandable, internally •
cooled, and perfusion electrodes).
In the RF ablation circuit, the (monopolar) electrode acts as the cathode and the •
pads as the anode.
The electrode tip concentrates high energy in a small area and the grounding •
pads disperse that energy due to the larger area.
There is a different algorithm used for each RF ablation application (ramped •
energy deposition or impedance regulated).
There are different ablation protocol types (time, use of isolating or ablation-•
enhancing agents) that vary according to the target organ.
The main limitation of RF ablation is that it depends on the appropriate thermal •
conductivity of the surrounding tissues.
Desiccated tissue around the electrode acts as an insulating agent and limits thermal •
energy transmission.
If the temperature rapidly reaches above 100°C, then boiling, vaporization, and •
carbonization occur, all of which decrease energy transmission and limit the
ablation effect.
The objective is to heat the surrounding tissues between 50°C and 100°C for •
more than 9 min without causing charring or vaporization.
To avoid tissue desiccation (charring) and vaporization, gradual tissue energy •
deposition needs to be performed.
A 1-cm “ablation margin” is necessary around the treated lesion to cover micro-•
scopic tumor extension.
The effectiveness of the ablation process is also limited by the “heat sink” effect •
due to the presence of adjacent blood vessels.
The development of a thermal lesion is described by the following relationship: •
induced coagulation necrosis = (energy deposited × local tissue interactions) –
heat loss.
The temperature of the surrounding tissues is inversely proportional to the dis-•
tance from the tip of the electrode. The relationship is described by the following
equation: T = 1/ r
4
where T is the temperature and r is the radius around the
electrode.
There is a limited area of 2.2–2.4 cm of ablation around a single needle-like •
electrode.
The ablation process may be enhanced by (a) improving the conduction of thermal •
energy, (b) decreasing the heat tolerance of the tumor, and (c) increasing the
energy deposition.
Types of Electrodes
The RF electrode has an insulated shaft and a noninsulated active tip, which is in •
contact with the lesion.
Initially electrodes were single and straight offering a cylindrical ablation zone. •
Electrode shape modi fi cation to a central cannula and multiple externally curved •
noninsulated extensions in the shape of an umbrella then occurred.
https://t.me/med1917
Соседние файлы в папке Библиотека им академика М.И. Перельмана