DOI:10.2214/AJR.07.3898
AJR 2008; 191:W75
© American Roentgen Ray Society
Reply
Yue-Yong Xiao,
Jin-Lin Tian and
Jin-Shan Zhang
Chinese PLA General Hospital Beijing, China
Chinese PLA 252 Hospital BaoDing Hebei Province, China
Chinese PLA General Hospital Beijing, China
WEB—This is a Web exclusive article.
We are pleased with the response to our article
[1] and appreciate the two
important points regarding contrast media and the double-oblique puncture
approach raised by Dr. De Filippo and colleagues
[2]. As for the first point, we
wrote in the Procedure portion of the Material and Methods section of our
article, "For small lesions (< 3 cm), alcohol was used for the
ablation. For large tumors (> 3 cm), a 50% acetic acid solution (99.9%
acetic acid added the half of iodized oil) was used." The contrast
medium used to mix with acetic acid was iodized oil, and the quantity of
iodized oil was the half of the acetic acid calculated on the basis of the
formula, 
= 4/
(R + 0.3)3.
As for guidance, CT is a good imaging technique for adrenal chemical
ablation because of its higher resolution and accurate localization
[3,
4]. In our study, CT was
performed with LightSpeed 16 helical scanners (GE Healthcare). Actually, the
double-oblique approach was widely used in our many CT-guided procedures. The
double-oblique approach includes medial–lateral and cranial–caudal
(or caudal–cranial) oblique angles; the former can be measured by axial
images, and the latter is the gantry oblique angle.
In the left adrenal gland, when the lesion is small (< 2 cm) and
occasionally the abdominal aorta and left kidney are very near the gland, the
double-oblique approach could be used to avoid penetrating adjacent organs,
although there is a possibility of inserting the needle through the lung and
diaphragm. When a fine needle (22-gauge) was used, usually no complications
occurred even if the needle was inserted through the lung and diaphragm. We
even punctured the left adrenal gland through the lung and diaphragm in
several cases. No pneumothorax or respiratory movement disorders occurred
(Fig. 1).
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Fig. 1 —MDCT-guided chemical ablation in 42-year-old man with
functional pheochromocytoma in left adrenal gland. On native axial view,
needle was inserted through lung and diaphragm into adrenal gland
(arrowhead). No pneumothorax or respiratory movement disorders
occurred after puncture. L = lung, D = diaphragm.
|
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In our study [1], the
positions of left adrenal lesions were high, and it was not necessary to scan
with a cranial–caudal angle. Thus the design of the needle path should
depend on the position of the lesions and their anatomic relationship to the
adjacent organs.
References
- Xiao YY, Tian JL, Li JK, et al. CT-guided percutaneous chemical
ablation of adrenal neoplasms. AJR 2008;190
: 105-110[Abstract/Free Full Text]
- De Filippo M, Onniboni M, Zompatori M. Double-oblique approach for
MDCT-guided needle biopsy or ablation in adrenal tumors using multiplanar
reconstruction. (letter) AJR 2008;191
:[web] W74[Free Full Text]
- Mayo-Smith WW, Dupuy DE. Adrenal neoplasms: CT-guided
radiofrequency ablation—preliminary results.
Radiology 1999;213
: 612-615[Abstract/Free Full Text]
- 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. Radiology2004; 231:225
-230[Abstract/Free Full Text]
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