Percutaneous Gadolinium Injection under MR Guidance to Mark Target for CT-guided Radiofrequency Ablation

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Selection of the appropriate imaging tool depends on a number of factors that reflect the patient, the procedure, and the physician. Multiple imaging techniques are often required to perform elements of a whole procedure. A patient with an allergy to iodinated contrast material and a 3.0-cm hepatic metastasis that was invisible on computed tomography (CT) was treated with CT-guided radiofrequency ablation by first injecting gadolinium under magnetic resonance guidance to mark the location of the lesion. Gadolinium's high atomic number makes it a viable contrast agent for attenuating x rays under fluoroscopic or CT guidance.

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CASE REPORT

A 71-year-old woman with a history of lymph-node–positive sigmoid colon cancer resected in 1998 presented to our hospital asymptomatic, but with an increasing carcinoembryonic antigen level. Because of the patient's history of anaphylactic reaction to iodinated contrast material, she underwent noncontrast CT, which revealed no evidence of disease. The patient had both gadolinium-enhanced MR imaging and positron emission tomographic scans which confirmed a solitary 3.0-cm-diameter lesion in the

DISCUSSION

Interventionalists have a number of imaging modalities available to perform image-guided procedures. A number of factors influence which of these modalities will be most appropriate for the given procedure. In the current case, the patient's lesion was not visible with US or noncontrast CT. Her allergic reaction to iodinated contrast material precluded an enhanced CT scan. However, her lesion was very conspicuous on all MR sequences.

MR-compatible biopsy tools are available to perform biopsy

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