DOI:10.2214/AJR.07.3815
AJR 2008; 191:W74
© American Roentgen Ray Society
Double Oblique Approach for MDCT-Guided Needle Biopsy or Ablation in Adrenal Tumors Using Multiplanar Reconstruction
Massimo De Filippo,
Mario Onniboni and
Maurizio Zompatori
University of Parma Parma Hospital Parma, Italy
WEB—This is a Web exclusive article.
We have carefully read the interesting article by Xiao et al.
[1], "CT-Guided
Percutaneous Chemical Ablation of Adrenal Neoplasms," published in the
January 2008 issue of the AJR. In particular, we appreciated the
detailed discussion and the excellent images. The article describes the
feasibility of chemical ablation for adrenal neoplasms. Only a few reports on
a limited number of patients treated with chemical ablation for adrenal
neoplasm have been published. Usually, chemical ablation has been used to
treat neoplasms of the liver, bone, kidney, lung, and other organs
[2,
3]. The traditional treatment
for primary adrenal neoplasms has been open surgical resection and
laparoscopic resection [4].
Surgical resection for isolated adrenal metastasis has been advocated by some
authors, although this treatment remains controversial.
Less-invasive techniques for the treatment of adrenal neoplasms include
radiofrequency ablation, selective arterial embolization, and injection of
alcohol or acetic acid (chemical ablation). We believe that acetic acid has
the ability to penetrate tumor septa and is known to diffuse better throughout
a lesion than ethanol; in addition, a smaller volume of acetic acid is needed
to chemically ablate a lesion.
View larger version (163K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1A —65-year-old man with cutaneous melanoma sites in trunk and
small metastatic melanoma (< 8 mm) to left adrenal gland. Axial image of
MDCT-guided biopsy clearly shows needle tip (arrow) within adrenal
gland (arrowheads). Note that needle is in close contact with side
wall of abdominal aorta and left kidney without penetrating them. AA =
abdominal aorta, LK = left kidney.
|
|
View larger version (35K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1B —65-year-old man with cutaneous melanoma sites in trunk and
small metastatic melanoma (< 8 mm) to left adrenal gland. Multiplanar
reformation (MPR) images obtained in left parasagittal view (B) and
oblique axial view (C) generated to check relationship between needle
tip (arrows) and retroperitoneal organs show that needle track is
free of organs and needle tip is shown within adrenal gland
(arrowheads, B). Double-oblique approach (medial–lateral
and cranial–caudal) of MDCT-guided needle biopsy using MPR makes it
possible to choose best way to biopsy lesion without penetrating abdominal
aorta or left kidney (arrowheads, C). AA = abdominal aorta, LK
= left kidney, N = needle.
|
|
View larger version (104K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1C —65-year-old man with cutaneous melanoma sites in trunk and
small metastatic melanoma (< 8 mm) to left adrenal gland. Multiplanar
reformation (MPR) images obtained in left parasagittal view (B) and
oblique axial view (C) generated to check relationship between needle
tip (arrows) and retroperitoneal organs show that needle track is
free of organs and needle tip is shown within adrenal gland
(arrowheads, B). Double-oblique approach (medial–lateral
and cranial–caudal) of MDCT-guided needle biopsy using MPR makes it
possible to choose best way to biopsy lesion without penetrating abdominal
aorta or left kidney (arrowheads, C). AA = abdominal aorta, LK
= left kidney, N = needle.
|
|
However, two points need to be further explained about materials and
methods. In particular, the authors did not describe how many and which
contrast media were used to mix with acetic acid. In the left adrenal gland,
especially when the lesion is small (< 2 cm), often it is difficult to find
a safe route to insert the needle into the lesion. During percutaneous needle
biopsy or ablation of left adrenal gland lesions, when the abdominal aorta and
left kidney are very near the gland, we use multiplanar reconstruction (MPR)
images (Figs. 1A,
1B, and
1C). Have the authors done the
same thing?
The MPR images obtained with MDCT make it possible to reach left adrenal
gland lesions once considered inaccessible with only the guidance of MDCT
axial images, because often the left adrenal gland is "covered" by
the abdominal aorta or left kidney.
In conclusion, we think the article by Xiao and colleagues
[1] is very interesting, but
probably the authors should discuss the two points above.
References
- Xiao YY, Tian JL, Li JK, Yang L, Zhang JS. CT-guided percutaneous
chemical ablation of adrenal neoplasms. AJR2008; 190:105
-110[Abstract/Free Full Text]
- Luo BM, Wen YL, Yang HY, et al. Percutaneous ethanol injection,
radiofrequency and their combination in treatment of hepatocellular carcinoma.
World J Gastroenterol 2005;11
: 6277-6280[Medline]
- Liang HL, Pan HB, Lee YH, et al. Small functional adrenal cortical
adenoma: treatment with CT-guided percutaneous acetic acid
injection—report of three cases. Radiology1999; 213:612
-615[Abstract/Free Full Text]
- Hawksworth J, Geisinger K, Zagoria R, et al. Surgical and ablative
treatment for metastatic adenocarcinoma to the liver from unknown primary
tumor. Am Surg 2004;70
: 512-517[Medline]
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
Y.-Y. Xiao, J.-L. Tian, and J.-S. Zhang
Reply
Am. J. Roentgenol.,
August 1, 2008;
191(2):
W75 - W75.
[Full Text]
[PDF]
|
|
|
Top
References
