Author: Prof. Martin Skalej. M.D.

University Hospital of Magdeburg, Germany

Patient History

68-year-old female with known renal cell carcinoma first diagnosed in 1996 with worsening pain in the upper thoracic spine. Patient showed discrete paresis of the left arm, but no other neurologic deficit.

Pre-treatment Imaging

MRI of the spine revealed a large metastasis with destruction of the second thoracic vertebra and extensive intraspinal and paravertebral infiltration and slight compression of the myelon (Fig. 1). The lesion extends to the trachea and the aortic arch ventrally and the lungs laterally. No other spinal metastases were detected.

Treatment

The patient was considered inoperable concerning tumor resection and vertebral body replacement. Thus radiofrequency ablation and subsequent radiation therapy was planned. For radiofrequency ablation, first imaging with syngo DynaCT was performed. iGuide CAPPA superimposes the puncture needle on the syngo DynaCT data set for precise placement (Fig. 2a + b). Then the electrodes were introduced through the puncture needle. The final position achieved according to the electromagnetic tracking system was confirmed by another syngo DynaCT run (optional) (Fig. 3) and the ablation was conducted with a total energy of 40 kJ. The patient tolerated the intervention without any complication; pain improved immediately after the procedure.

Comments

The electromagnetic tracking system in combination with syngo DynaCT allows precise placement of electrodes or biopsy devices even in regions that are difficult to evaluate with fluoroscopy or where critical anatomic structures not visible with fluoroscopy alone must be avoided. The tracking system provides excellent depiction of the progression of the needles and anatomic detail is provided by syngo DynaCT. Also no further imaging is necessary during the intervention. X-ray exposure to the examiners is reduced when compared to interventions performed under CT-fluoroscopy guidance. If wanted, a control scan can be performed to document the final position.

Fig 1: T1-weighted image without gadolinium enhancement demonstrates large metastasis with intraspinal growth and extension to the lungs, the aortic arch, the trachea and the esophagus.

Fig 2 a+b: The electromagnetic tracking shows progression of the needle into the soft tissue mass.

Fig 3: Documentation of the final position of the electrodes with syngo DynaCT. The image was reconstructed on the syngo X Workplace.

 Download Case[332 KB]