Nadine Maya Shabeeb

Results of a study by Greek researchers suggest that percutaneous disc decompression, a newly developed outpatient procedure for herniated vertebral discs, has better long-term effects than conservative therapy. They released findings at the 2009 RSNA meeting.

Percutaneous disc decompression involves inserting a needle into a herniated disc and removing tissue under an imaging guidance system. The procedure, which is done under local anesthetic, is minimally invasive and takes 15 to 60 minutes, depending on the number of discs being treated.

“This is for patients who do not have a motor deficit. They can walk normally, but they're in pain,” said Dr. Alexis Kelekis, an assistant professor of interventional radiology at the University of Athens.

The study consisted of two groups with 31 patients each, all of whom had a history of unsuccessful medical treatment for back or leg pain. One group was randomly assigned to undergo the interventional treatment, which Kelekis described as slightly painful. The other group underwent rigorous conservative therapy, which included physiotherapy and anti-inflammatory drugs. There were no previous differences between the two groups.

Patients who were chosen to participate had clinical symptoms that were concordant with their herniated discs. Patients in both groups reported positive results after three months. Those who underwent the percutaneous disc treatment continued to report decreased pain at 12- and 24-month follow-up. Those under rigorous conservative therapy, however, reported increased pain and decreased mobility after 12 months. Their negative symptoms increased through the 24-month period.

“The effect of the drugs lasts for a while, but slowly the pain comes back. You have to retake the drugs and restart the cycle,” Kelekis said.

According to Kelekis, patients who underwent the percutaneous disc treatment had a slower curve in the beginning, but its effect was sustained over the 24-month follow-up period. While some patients had immediate positive results, the complete effect took approximately three to six months.

“In a way we're imitating what nature will do in the following years by mechanically degenerating those discs,” Kelekis said.

Kelekis stressed the importance of talking to the patient about both the procedure itself and other relevant clinical information.

Articles

Results of a study by Greek researchers suggest that percutaneous disc decompression, a newly developed outpatient procedure for herniated vertebral discs, has better long-term effects than conservative therapy.

Image-guided spine intervention leads to back pain relief

Breast cancer detection rates increase substantially when women at high risk and those with dense breasts undergo mammography and ultrasound annually, according to a study presented Wednesday at the 2009 RSNA meeting. MRI is an even more effective technique when used with mammography, but only for women who are at high risk for the condition. 

 Mammography is the only test to date that is proven to reduce mortality due to breast cancer. Adding MRI to the equation could be a more effective technique for detection of malignancy, said lead researcher Dr. Wendie A. Berg, breast imaging specialist at American Radiology Services, Johns Hopkins–Green Spring Station in Lutherville, MD. 

 According to Berg, women at high risk could benefit most from the imaging combo. This includes women with the BRCA 1 or BRCA 2 gene, those with a close relative who has had breast cancer, and women who are at elevated risk for other reasons. Overall, these patients make up less than a fifth of the general female population. Due to MRI’s high cost, it might make more sense to apply this combined imaging protocol only to women in these subgroups, Berg said. 

 The study involved 2809 women from the U.S., Canada, and Argentina with heterogeneously dense breasts who had some elevated risk for breast cancer. The women underwent mammogram and ultrasound annually for three years. In the third year 612 of the subjects also underwent MR imaging. 

 Ultrasound increased the cancer detection rate by 29% when used in conjunction with mammography, which detected 56% of cancers when used alone. A downside of ultrasound is that it increases the number of false-positive findings. Using ultrasound with mammography led to a 5% increase in biopsies, but only 10% of these cases were cancerous.

MRI combined with mammography was the most sensitive detection method at 100%. MR increased the biopsy rate by nearly 10%, with a consequent jump in the number of false positive findings. However, it also increased detection of malignancies. One in four cases undergoing MR evaluation turned out with cancers, which Berg described as an acceptable rate. 

 “A needle biopsy under ultrasound guidance is a 15-minute procedure done under local anesthesia,” she said. “The vast majority of women I’ve ever talked to feel that this is not an issue. They’d much rather have this extra test and be more confident that they do not have a life-threatening cancer.”

Breast cancer detection rates increase substantially when women at high risk and those with dense breasts undergo mammography and ultrasound annually, according to a study presented Wednesday at the 2009 RSNA meeting. MRI is an even more effective technique when used with mammography, but only for women who are at high risk for the condition.

Multimodality breast cancer screening shows possible boon for high-risk women

Results of a study by Greek researchers suggest that percutaneous disc decompression, a newly developed outpatient procedure for herniated vertebral discs, has better long-term effects than conservative therapy. They released findings Wednesday at the 2009 RSNA meeting. 

  Percutaneous disc decompression involves inserting a needle into a herniated disc and removing tissue under an imaging guidance system. The procedure, which is done under local anesthetic, is minimally invasive and takes 15 to 60 minutes, depending on the number of discs being treated. 

 	 “This is for patients who do not have a motor deficit. They can walk normally, but they’re in pain,” said Dr. Alexis Kelekis, assistant professor of interventional radiology at the University of Athens. 

 	 The study consisted of two groups with 31 patients each, all of whom had a history of unsuccessful medical treatment for back or leg pain. One group was randomly assigned to undergo the interventional treatment, which Kelekis described as slightly painful. The other group underwent rigorous conservative therapy, which included physiotherapy and anti-inflammatory drugs. There were no previous differences between the two groups. Patients who were chosen to participate had clinical symptoms that were concordant with their herniated discs. 

 	 Patients in both groups reported positive results after three months. Those who underwent the percutaneous disc treatment continued to report decreased pain at 12- and 24-month follow-up. Those under rigorous conservative therapy, however, reported increased pain and decreased mobility after 12 months. Their negative symptoms increased through the 24-month period. 

 	 “The effect of the drugs lasts for a while, but slowly the pain comes back. You have to retake the drugs and restart the cycle,” Kelekis said.

According to Kelekis, patients who underwent the percutaneous disc treatment had a slower curve in the beginning, but its effect was sustained over the 24-month follow-up period. While some patients had immediate positive results, the complete effect took approximately three to six months. 

 	 “In a way we’re imitating what nature will do in the following years by degenerating mechanically those discs,” Kelekis said. 

 	 Kelekis stressed the importance of talking to the patient about both the procedure itself and other relevant clinical information. 

 	 “This is a new notion that’s been introduced lately to interventional radiologists, that we have to have the clinical backup and support for this kind of information,” Kelekis said. “If you’re doing something only as a performer, then you lose contact with your patient, and sometimes you can be wrong doing your procedure.”

Results of a study by Greek researchers suggest that percutaneous disc decompression, a newly developed outpatient procedure for herniated vertebral discs, has better long-term effects than conservative therapy. They released findings Wednesday at the 2009 RSNA meeting.

Image-guided spine intervention yields long-term back pain relief

Targeted breast ultrasound is a safe and effective alternative to biopsies, and it can be used by radiologists to alleviate anxiety that patients may have about breast cancer screening, according to two studies presented Wednesday at the 2009 RSNA meeting.

“Breast imaging with ultrasound is a tool that can be used to decrease the harms and costs associated with unnecessary surgery,” said senior investigator Dr. Constance D. Lehman, vice chair of radiology at the University of Washington in Seattle.

Ultrasound was used to effectively differentiate cancerous masses from benign lumps. Advantages of targeted breast ultrasound include that it is both less invasive and less expensive than biopsy.

In the first study, Lehman and colleagues examined 1091 lesions in 830 female patients under the age of 30 who underwent ultrasound mainly for breast signs and symptoms. Three of the patients (0.4%) were found to have cancer, and each of these women had suspicious lumps, according to their ultrasound results.

“The overall incidence of cancer in these women under 30 is very low. Ultrasound is a 100% sensitivity tool in this setting, supporting its use as a primary imaging modality,” Lehman said.

The second study examined 1327 cases in 1032 women between the ages of 30 and 39 who underwent both ultrasound and mammography. Two percent of the cases were malignant and were all detected by ultrasound. However, none were detected by the mammogram alone, calling into question the added benefit of mammography in this setting.

Lehman also discussed the possibility of using ultrasound to test BI-RADS 3 lesions that are probably benign lumps, rather than doing a biopsy or performing surgery. In the first study, a third of the patients with BI-RADS 3 lesions opted to undergo tissue sampling, and none were found to be malignant.

“With these data we can be much more reassuring to patients on the very low likelihood of malignancy in these probably-benign lesions. In fact, in our hands it was zero percent,” said Lehman, who is also director of breast imaging at the Seattle Cancer Care Alliance.

According to Lehman, radiologists can use targeted breast ultrasound to directly challenge the anxieties associated with fear of breast cancer.

“This is an example where we have confidence our imaging tools can really give women much more security in these areas,” she said.

Targeted breast ultrasound is less invasive and expensive than biopsy, as well as reduces anxiety over breast cancer screening.

Nadine Maya Shabeeb

Articles

Image-guided spine intervention leads to back pain relief

Multimodality breast cancer screening shows possible boon for high-risk women

Image-guided spine intervention yields long-term back pain relief

Breast ultrasound spares young women unnecessary biopsies