nach oben

CardioVascular and Interventional Radiology

Erschienen in:

01.04.2013 | Clinical Investigation

MR-guided Neurolytic Celiac Plexus Ablation: An Evaluation of Effect and Injection Spread Pattern in Cancer Patients with Celiac Tumor Infiltration

verfasst von: Etem Akural, Risto O. Ojala, Voitto Järvimäki, Juho Kariniemi, Osmo A. Tervonen, Roberto Blanco Sequeiros

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 2/2013

Einloggen, um Zugang zu erhalten

Abstract

Objective

The purpose of this study was to evaluate the feasibility, the initial accuracy, and the effects of the MR-guided neurolytic celiac plexus ablation as a method to treat cancer-induced chronic abdominal pain.

Methods

Thirteen celiac plexus ablations were performed for 12 patients. A 0.23-T open MRI scanner with optical navigation was used for procedural guidance. As an adjunct to the MR-guided needle positioning, the needle location was confirmed with saline injection and consequent MR imaging (STIR sequence). The spread of the ablative injection material (alcohol-lidocaine mix) was observed by repeating this sequence after the therapeutic injection. Pain scores from seven patients (eight ablations) were used to assess the therapy effect.

Results

MR guidance allowed adequate needle positioning and visualization of injection material in all cases. The rest pain scores significantly decreased from 4 (median) at baseline to 1 (median) at 2 weeks (p < 0.05). Average and worst pain experienced during the past week were significantly lower at the 2-week time point compared with the baseline (p < 0.05). However, the intervention did not result in reduction of opioid use at 2 weeks.

Conclusions

MR guidance is an accurate and safe method for celiac plexus ablation with positive therapeutic effect.

Eisenberg E, Carr DB, Chalmers TC (1995) Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis. Anesth Analg 80(2):290–295PubMed

de Oliveira R, dos Reis MP, Prado WA (2004) The effects of early or late neurolytic sympathetic plexus block on the management of abdominal or pelvic cancer pain. Pain 110(1–2):400–408PubMedCrossRef

Zhang CL, Zhang TJ, Guo YN et al (2008) Effect of neurolytic celiac plexus block guided by computerized tomography on pancreatic cancer pain. Dig Dis Sci 53(3):856–860PubMedCrossRef

Fritz J, Konig CW, Gunaydin I et al (2005) Magnetic resonance imaging-guided corticosteroid-infiltration of the sacroiliac joints: pain therapy of sacroiliitis in patients with ankylosing spondylitis. Rofo 177(4):555–563PubMedCrossRef

Sequeiros RB, Ojala R, Kariniemi J et al (2005) MR-guided interventional procedures: a review. Acta Radiol 46(6):576–586PubMedCrossRef

Lu DS, Reber HA, Krasny RM, Kadell BM, Sayre J (1997) Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. Am J Roentgenol 168(6):1439–1443CrossRef

Ojala R, Vahala E, Karppinen J et al (2000) Nerve root infiltration of the first sacral root with MRI guidance. J Magn Reson Imaging 12(4):556–561PubMedCrossRef

Hayakawa J, Kobayashi O, Murayama H (1997) Paraplegia after intraoperative celiac plexus block. Anesth Analg 84(2):447–448PubMed

Navarro-Martinez J, Montes A, Comps O, Sitges-Serra A (2003) Retroperitoneal abscess after neurolytic celiac plexus block from the anterior approach. Reg Anesth Pain Med 28(6):528–530PubMed

10.

Hol PK, Kvarstein G, Viken O, Smedby O, Tonnessen TI (2000) MRI-guided celiac plexus block. J Magn Reson Imaging 12(4):562–564PubMedCrossRef

11.

Wong GY, Schroeder DR, Carns PE et al (2004) Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer: a randomized controlled trial. J Am Med Assoc 291(9):1092–1099CrossRef

12.

Polati E, Finco G, Gottin L, Bassi C, Pederzoli P, Ischia S (1998) Prospective randomized double-blind trial of neurolytic coeliac plexus block in patients with pancreatic cancer. Br J Surg 85(2):199–201PubMedCrossRef

13.

Moore DC (2004) The dreaded complications from neurolytic celiac plexus blocks are preventable! Reg Anesth Pain Med 29(4):377–378PubMed

14.

Thompson GE, Moore DC, Bridenbaugh LD, Artin RY (1977) Abdominal pain and alcohol celiac plexus nerve block. Anesth Analg 56(1):1–5PubMedCrossRef

15.

Singler RC (1982) An improved technique for alcohol neurolysis of the celiac plexus. Anesthesiology 56(2):137–141PubMedCrossRef

16.

Kaufman M, Singh G, Das S et al (2010) Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer. J Clin Gastroenterol 44(2):127–134PubMedCrossRef

17.

De Cicco M, Matovic M, Bortolussi R et al (2001) Celiac plexus block: injectate spread and pain relief in patients with regional anatomic distortions. Anesthesiology 94(4):561–565PubMedCrossRef

18.

Fritz J, Thomas C, Clasen S, Claussen CD, Lewin JS, Pereira PL (2009) Freehand real-time MRI-guided lumbar spinal injection procedures at 1.5 T: feasibility, accuracy, and safety. Am J Roentgenol 192(4):W161–W167CrossRef

19.

Iki K, Fujita Y, Inada H, Satoh M, Tsunoda T (2003) Celiac plexus block: evaluation of injectate spread by three-dimensional computed tomography. Abdom Imaging 28(4):571–573PubMedCrossRef

20.

Neuerburg J, Adam G, Bucker A et al (1998) [A new MR-(and CT-) compatible bone biopsy system: first clinical results]. Rofo 169(5):515–520PubMedCrossRef

21.

Tikkakoski T, Lahde S, Puranen J, Apaja-Sarkkinen M (1992) Combined CT-guided biopsy and cytology in diagnosis of bony lesions. Acta Radiol 33(3):225–229PubMed

22.

Streitparth F, Walter T, Wonneberger U et al (2010) Image-guided spinal injection procedures in open high-field MRI with vertical field orientation: feasibility and technical features. Eur Radiol 20(2):395–403PubMedCrossRef

23.

Sequeiros RB, Ojala RO, Klemola R, Vaara TJ, Jyrkinen L, Tervonen OA (2002) MRI-guided periradicular nerve root infiltration therapy in low-field (0.23-T) MRI system using optical instrument tracking. Eur Radiol 12(6):1331–1337PubMedCrossRef

24.

Buls N, Pages J, de Mey J, Osteaux M (2003) Evaluation of patient and staff doses during various CT fluoroscopy guided interventions. Health Phys 85(2):165–173PubMedCrossRef

Titel: MR-guided Neurolytic Celiac Plexus Ablation: An Evaluation of Effect and Injection Spread Pattern in Cancer Patients with Celiac Tumor Infiltration
verfasst von: Etem Akural
Risto O. Ojala
Voitto Järvimäki
Juho Kariniemi
Osmo A. Tervonen
Roberto Blanco Sequeiros
Publikationsdatum: 01.04.2013
Verlag: Springer-Verlag
Erschienen in: CardioVascular and Interventional Radiology / Ausgabe 2/2013
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-012-0417-x

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

MR-guided Neurolytic Celiac Plexus Ablation: An Evaluation of Effect and Injection Spread Pattern in Cancer Patients with Celiac Tumor Infiltration