Interventional Radiology Session

Budding Radiologist

09 Oct 2024 • 2 min read

Session Recap: Interventional Radiology for Desmoid Fibromatosis

Article: Desmoid Fibromatosis: Interventional Radiology (Sometimes) to the Rescue
Source: British Journal of Radiology
DOI: 10.1093/bjr/tqae128

Desmoid fibromatosis (DF) is a rare, locally aggressive benign tumor.
Non-metastatic but can recur locally; peaks in patients aged 30-40, with a higher incidence in females.
Pathogenesis: Related to dysregulation of the Wnt pathway, involving mutations in the CTNNB1 gene.

Treatment Options (Non-IR)

Surveillance: Active monitoring through MRI/CT.
Local Treatments: Surgery and radiotherapy are now second-line options.
Systemic Treatments: Chemotherapy (low-dose methotrexate), tyrosine kinase inhibitors, NSAIDs, and antiestrogens have shown varying efficacy.

Role of Interventional Radiology (IR)

IR techniques offer minimal invasiveness with fewer complications, such as:

Cryoablation: Gold standard for disease and pain control.
High-Intensity Focused Ultrasound (HIFU): Effective for large soft tissue masses.
Radiofrequency Ablation, Microwave Ablation: Alternative heat-based ablation techniques.
Transarterial Treatments (TACE): Used when cryoablation is not feasible.

Session Recap: Transvenous Embolization for CSF-Venous Fistulas

Article: Clinical and Imaging Outcomes of 100 Patients Treated with Transvenous Embolization of Cerebrospinal Fluid-Venous Fistulas (CSF-VF)
Source: American Journal of Neuroradiology
DOI: 10.3174/ajnr.A7409

Spontaneous Intracranial Hypotension (SIH): Caused by cerebrospinal fluid-venous fistulas, leading to headaches, tinnitus, and vision changes.
Transvenous Embolization: An effective minimally invasive treatment option for CSF-VF, especially when more conservative methods (e.g., epidural blood patch) are ineffective.

Key Results from the Study

Imaging Outcomes: Significant improvement in brain MRI findings post-procedure using the Bern SIH scoring system.
Clinical Outcomes: Most patients experienced symptom resolution or significant improvement.
Complications: Minimal, with some reporting mild postoperative pain and radiculopathy, which usually resolved over time.

Procedure Details

Embolization Technique: Utilizes a microcatheter advanced into the draining vein of the fistula followed by embolization with Onyx, a liquid embolic agent.
Outcomes: 95% success rate, low complication rate, and significant symptom relief in the majority of cases.

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